The use of three-dimensional anatomical patient-specific printed models in surgical clipping of intracranial aneurysm: A pilot study

Abstract

Background: In the present study, we aim to develop simulation models based on computed tomography angiography images of intracranial aneurysms (IAs) and their parent vessels using three-dimensional (3D) printing technology. The study focuses on the value of these 3D models in presurgical planning and intraoperative navigation and ultimately their impact on patient outcomes. To the best of our knowledge, this is the first report of its kind from a war-torn country, like Iraq.

Methods: This is a prospective study of a series of 11, consecutively enrolled, patients suffering from IAs for the period between February and September 2019. The study represents a collaboration between the two major neurosurgical centers in Baghdad/Iraq; Neurosciences Teaching Hospital and Neurosurgery Teaching Hospital. We analyzed the data of eleven patients with IAs treated by microsurgical clipping. These data include patient demographics, clinical, surgical, and outcomes along with the data of the 3D-printed replica used in these surgeries. All cases were operated on by one surgeon.

Results: Our study included 11 patients, with a total of 11 aneurysms clipped. The mean age was 44 ± 8, with a median of 42.5 and a range of 35-61 years. About 60% of our patients were female with a female-to-male ratio of 1:5. About 60% of the aneurysms were located at the anterior communicating artery (Acom) while the remaining 40% were equally distributed between the posterior communicating and internal carotid arteries bifurcation. The standard pterional approach was followed in 50% of cases, whereas the other 50% of patients were treated through the lateral supraorbital approach. About 90% (n = 9) of the patients had a Glasgow Outcome Scale (GOS) of 5 and 10% had a GOS of 4. The 3D-printed models successfully replicated the aneurysm size, location, and relation to the parent vessel with 100% accuracy and were used for intraoperative guidance. The average production time was 24-48 h and the production cost was 10-20 US dollars.

Conclusion: 3D printing is a promising technology that is rapidly penetrating the field of neurosurgery. In particular, the use of 3D-printed patient-matched, anatomically accurate replicas of the cerebral vascular tree is valuable adjunct to the microsurgical clipping of IAs, and our study conclusions support this concept. However, both the feasibility and clinical utility of 3D printing remain the subject of much, ongoing investigations.

Keywords: Aneurysm surgery; Neurosurgery; Rapid prototyping; Three-dimensional printing.

Figure 1:

Images showing the comparison between: (a) the CT angiography image of (5 mm) posterolateral directed right posterior communicating artery aneurysm. The aneurysm (red arrow) and the basal vein of Rosenthal (yellow arrow). (b) 3D physical prototyped biomodel, (c) the intraoperative finding, before the clipping (c) and after the clipping (d). A1: Anterior cerebral artery, precommunicating segment. An: Aneurysm. ICA: Internal carotid artery. II: Optic nerve.

Figure 2:

A case of large anterior communicating artery aneurysm. CT angiography three-dimensional (3D) reconstructed image (a). The 3D prototyped biomodel of the aneurysm, surrounding arteries and the skull base viewed from different angle to enhance preoperative planning and thus intraoperative orientation (b and c). Green arrow: Aneurysm.