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Additive Manufacturing for Personalized Skull Base Reconstruction in Endoscopic Transclival Surgery: A Proof-of-Concept Study
- Source :
- World Neurosurgery. 155:e439-e452
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Background Endoscopic transnasal transclival intradural surgery is limited by a high postoperative cerebrospinal fluid leak rate. The aim of this study was to investigate the role of three-dimensional printing to create a personalized, rigid scaffold for clival reconstruction. Methods Two different types of clivectomy were performed in 5 specimens with the aid of neuronavigation, and 11 clival reconstructions were simulated. They were repaired with polylactide, three-dimensional–printed scaffolds that were manually designed in a computer-aided environment based either on the real or on the predicted defect. Scaffolds were printed with a fused filament fabrication technique and different offsets. They were positioned and fixed either following the gasket seal technique or with screws. Postdissection radiological evaluation of scaffold position was performed in all cases. In 3 specimens, the cerebrospinal fluid leak pressure point was measured immediately after reconstruction. Results The production process took approximately 30 hours. The designed scaffolds were satisfactory when no offset was added. Wings were added during the design to allow for screw positioning, but broke in 30% of cases. Radiological assessment documented maximal accuracy of scaffold positioning when the scaffold was created on the real defect; accuracy was satisfactory when the predicted clivectomy was performed under neuronavigation guidance. The cerebrospinal fluid leak pressure point was significantly higher when the scaffold was fixed with screws compared with the gasket technique. Conclusions In this preclinical setting, additive manufacturing allows the creation of customized scaffolds that are effective in reconstructing even large and geometrically complex clival defects.
- Subjects :
- medicine.medical_specialty
Scaffold
Neuronavigation
Additive manufacturing
medicine.medical_treatment
Bone Screws
Base (geometry)
3D printing
Fused filament fabrication
Posterior
Proof of Concept Study
Cranial Fossa
Cranioplasty
Imaging
Imaging, Three-Dimensional
Skull base reconstruction
medicine
Humans
Endoscopic transclival surgery
Personalized bone reconstitution
Computer Simulation
Reconstructive Surgical Procedures
Precision Medicine
Tomography
Skull Base
Cerebrospinal Fluid Leak
Cerebrospinal fluid leak
business.industry
Gasket
Cranial Fossa, Posterior
Neuroendoscopy
Printing, Three-Dimensional
Tomography, X-Ray Computed
Plastic Surgery Procedures
medicine.disease
X-Ray Computed
Surgery
Three-Dimensional
Printing
Neurology (clinical)
business
Subjects
Details
- ISSN :
- 18788750
- Volume :
- 155
- Database :
- OpenAIRE
- Journal :
- World Neurosurgery
- Accession number :
- edsair.doi.dedup.....dad322e17f6f6e576de7d164b8594c06