Movement Disorders Unit, Neurology and Clinical Neurophysiology Service, Seville Institute of Biomedicine, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain; Biomedical Research Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain.
Neurosurgery Service, Virgen del Rocío University Hospital, Seville, Spain.
World Neurosurg. 2021 Mar;147:164-171.e4. doi: 10.1016/j.wneu.2020.12.082. Epub 2021 Jan 5.
Surgical resection of diffuse low-grade gliomas (DLGGs) involving cortical eloquent areas and subcortical functional pathways represents a challenge in neurosurgery. Patient-specific, 3-dimensional (3D)-printed models of head and brain structures have emerged in recent years as an educational and clinical tool for patients, doctors, and surgical residents.
Using multimodal high-definition magnetic resonance imaging data, which incorporates information from specific task-based functional neuroimaging and diffusion tensor imaging tractography and rapid prototyping technologies with specialized software and "in-house" 3D printing, we were able to generate 3D-printed head models that were used for preoperative patient education and consultation, surgical planning, and resident training in 2 complicated DLGG surgeries.
This 3D-printed model is rapid prototyped and shows a means to model individualized, diffuse, low-level glioma in 3D space with respect to cortical eloquent areas and subcortical pathways. Survey results from 8 surgeons with different levels of expertise strongly support the use of this model for surgical planning, intraoperative surgical guidance, doctor-patient communication, and surgical training (>95% acceptance).
Spatial proximity of DLGG to cortical eloquent areas and subcortical tracts can be readily assessed in patient-specific 3D printed models with high fidelity. 3D-printed multimodal models could be helpful in preoperative patient consultation, surgical planning, and resident training.
涉及皮质功能区和皮质下功能通路的弥漫性低级别胶质瘤（DLGGs）的外科切除对神经外科来说是一个挑战。近年来，患者特异性、三维（3D）打印的头颅和脑组织模型已经成为一种教育和临床工具，可供患者、医生和外科住院医师使用。
我们使用多模态高分辨率磁共振成像数据，该数据结合了特定任务的功能神经影像学和弥散张量成像示踪技术以及快速原型制作技术、专用软件和“内部”3D 打印，生成 3D 打印头颅模型，用于 2 例复杂 DLGG 手术中的术前患者教育和咨询、手术计划以及住院医师培训。
该 3D 打印模型快速原型化，能够以 3D 空间方式对个体化、弥漫性、低级别胶质瘤进行建模，考虑到皮质功能区和皮质下通路。来自不同专业水平的 8 位外科医生的调查结果强烈支持该模型在手术计划、术中手术指导、医患沟通和手术培训中的应用（>95%的接受率）。
DLGG 与皮质功能区和皮质下束的空间接近程度可以在具有高保真度的患者特异性 3D 打印模型中得到很好的评估。多模态 3D 打印模型可有助于术前患者咨询、手术计划和住院医师培训。
