Nagassa Ruth G, McMenamin Paul G, Adams Justin W, Quayle Michelle R, Rosenfeld Jeffrey V
Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia.
Monash Institute of Medical Engineering, Monash University, Clayton, VIC, Australia.
3D Print Med. 2019 Aug 1;5(1):11. doi: 10.1186/s41205-019-0048-9.
Neurosurgical residents are finding it more difficult to obtain experience as the primary operator in aneurysm surgery. The present study aimed to replicate patient-derived cranial anatomy, pathology and human tissue properties relevant to cerebral aneurysm intervention through 3D printing and 3D print-driven casting techniques. The final simulator was designed to provide accurate simulation of a human head with a middle cerebral artery (MCA) aneurysm.
This study utilized living human and cadaver-derived medical imaging data including CT angiography and MRI scans. Computer-aided design (CAD) models and pre-existing computational 3D models were also incorporated in the development of the simulator. The design was based on including anatomical components vital to the surgery of MCA aneurysms while focusing on reproducibility, adaptability and functionality of the simulator. Various methods of 3D printing were utilized for the direct development of anatomical replicas and moulds for casting components that optimized the bio-mimicry and mechanical properties of human tissues. Synthetic materials including various types of silicone and ballistics gelatin were cast in these moulds. A novel technique utilizing water-soluble wax and silicone was used to establish hollow patient-derived cerebrovascular models.
A patient-derived 3D aneurysm model was constructed for a MCA aneurysm. Multiple cerebral aneurysm models, patient-derived and CAD, were replicated as hollow high-fidelity models. The final assembled simulator integrated six anatomical components relevant to the treatment of cerebral aneurysms of the Circle of Willis in the left cerebral hemisphere. These included models of the cerebral vasculature, cranial nerves, brain, meninges, skull and skin. The cerebral circulation was modeled through the patient-derived vasculature within the brain model. Linear and volumetric measurements of specific physical modular components were repeated, averaged and compared to the original 3D meshes generated from the medical imaging data. Calculation of the concordance correlation coefficient (ρ: 90.2%-99.0%) and percentage difference (≤0.4%) confirmed the accuracy of the models.
A multi-disciplinary approach involving 3D printing and casting techniques was used to successfully construct a multi-component cerebral aneurysm surgery simulator. Further study is planned to demonstrate the educational value of the proposed simulator for neurosurgery residents.
神经外科住院医师发现越来越难以获得作为动脉瘤手术主刀医生的经验。本研究旨在通过3D打印和3D打印驱动的铸造技术，复制与脑动脉瘤干预相关的患者来源的颅骨解剖结构、病理和人体组织特性。最终的模拟器旨在精确模拟患有大脑中动脉（MCA）动脉瘤的人头。
本研究利用了活体人类和尸体来源的医学影像数据，包括CT血管造影和MRI扫描。计算机辅助设计（CAD）模型和现有的计算3D模型也被纳入模拟器的开发中。该设计基于纳入对MCA动脉瘤手术至关重要的解剖成分，同时注重模拟器的可重复性、适应性和功能性。利用各种3D打印方法直接开发解剖复制品和用于铸造部件的模具，以优化人体组织的生物模拟和机械性能。在这些模具中铸造包括各种类型硅胶和弹道明胶在内的合成材料。一种利用水溶性蜡和硅胶的新技术被用于建立空心的患者来源的脑血管模型。
构建了一个用于MCA动脉瘤的患者来源的3D动脉瘤模型。多个患者来源的和CAD的脑动脉瘤模型被复制为空心的高保真模型。最终组装的模拟器整合了六个与左脑半球 Willis 环脑动脉瘤治疗相关的解剖成分。这些包括脑血管、颅神经、脑、脑膜、颅骨和皮肤的模型。通过脑模型内患者来源的血管系统对脑循环进行建模。对特定物理模块组件进行线性和体积测量，重复测量、求平均值并与从医学影像数据生成的原始3D网格进行比较。一致性相关系数（ρ：90.2%-99.0%）和百分比差异（≤0.4%）的计算证实了模型的准确性。
采用涉及3D打印和铸造技术的多学科方法成功构建了一个多组件脑动脉瘤手术模拟器。计划进一步开展研究以证明所提出的模拟器对神经外科住院医师的教育价值。
