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Table of Contents
LETTER TO THE EDITOR
Year : 2023  |  Volume : 26  |  Issue : 1  |  Page : 81-84
 

Application of 3D printing in individualized treatment of intracranial aneurysms


1 Department of Neurosurgery, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, China
2 Department of Radiotherapy, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, China
3 Capital Medical University, Beijing, China

Date of Submission08-Feb-2022
Date of Decision02-Dec-2022
Date of Acceptance09-Dec-2022
Date of Web Publication18-Jan-2023

Correspondence Address:
Qing Huang
Department of Neurosurgery, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aian.aian_133_22

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How to cite this article:
Wang S, Huang Q, Yuan J, Zhang H, Yang N, Pang Z. Application of 3D printing in individualized treatment of intracranial aneurysms. Ann Indian Acad Neurol 2023;26:81-4

How to cite this URL:
Wang S, Huang Q, Yuan J, Zhang H, Yang N, Pang Z. Application of 3D printing in individualized treatment of intracranial aneurysms. Ann Indian Acad Neurol [serial online] 2023 [cited 2023 Feb 1];26:81-4. Available from: https://www.annalsofian.org/text.asp?2023/26/1/81/368039





   Introduction Top


It is well known that intracranial aneurysm is a very dangerous cerebrovascular disease,[1] which can cause recurrent subarachnoid hemorrhage, and the rates of death and disability are high.[2] Currently, clipping surgery and endovascular embolization are used to treat intracranial aneurysms.[3] Aneurysm clipping surgery is very difficult due to the ever-changing aneurysm morphology, complex peripheral vascular structure, and extremely irregular surrounding skull base bone.[4] Therefore, the success of aneurysm clipping surgery depends on if we can get the information as much as possible.[5]

With the development of digital medicine, three-dimensional (3D) printing technology applications have been paid more and more attention in the medical field,[6] the technology has been widely used in bone,[7] oral surgery,[8] and blood vessels.[9],[10] Studies have shown that 3D printing has significant application value in intracranial aneurysm models of clinical teaching, operation simulation, and accurate operation scheme of the path of the formulation.[11],[12],[13],[14],[15],[16] In this study, 3D printing technology was used to construct the craniocerebral anatomy model of patients with a cerebral aneurysm, and the model was simulated before the operation by surgeons.[17] By comparing the operative time, hospitalization time, and postoperative neurological function recovery of patients with intraoperative aneurysms,[18] the application effect of preoperative simulation using a 3D printing model in aneurysm clipping surgery was evaluated.


   Materials and Methods Top


From February 2017 to February 2019, 72 patients with cerebral aneurysms received in our neurosurgery department were randomly divided into the 3D printing simulation group and the conventional aneurysm clipping surgery group. Simulation group: A 3D model simulation group of aneurysm patients was used to simulate the operation of the aneurysm using the craniocerebral holistic 3D printing model [Figure 1].
Figure 1: 1. Aneurysm; 2. anterior communicating artery; 3. vertebral artery; 4. posterior communicating artery; 5. middle cerebral artery; 6. anterior cerebral artery; 7. basilar artery; 8. skull

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Preoperative preparation and surgical simulation

Preoperative according to 3D print model, evaluation of aneurysm and adjacent to the bone, arteries and veins, the nerves and brain anatomical relationships occlusion, aneurysm dome head, design of the optimal surgical approach, the simulation of the separation of the aneurysm neck operation, choosing the best-placed aneurysm clip, and applies the model to the intraoperative reference for the performer; [Figure 2].
Figure 2: (a) 3D-printed brain model containing brain tissue; (b) select the left side according to the location of the aneurysm. The frontal, temporal key point approach was used to open the bone window. (c) Expose the aneurysm and select an appropriate aneurysm clip for clipping (aneurysm clip shown in blue arrow); (d) the aneurysmal neck is clearly visible after clipping (blue). The aneurysm neck (arrow) is completely clipped

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   Results Top


The 3D-printed craniocerebral models were used to design the surgical route. The actual surgery was based on the results of the simulated surgery. The intraoperative exposure time of the simulation group ([132.75 ± 73.05] min) was significantly shorter than that of the control group ([221.67 ± 113.36] min, P < 0.05). There was no significant difference in the length of hospital stay between the two groups (P > 0.05). The Glasgow Outcome Scale score ([5.00] points), the National Institutes of Health Stroke Scale score (0), and the Barthel index difference (100.00) in the simulation group six months after surgery were significantly higher than those in the control group ([3.5], [4.5], and (82.5) points, respectively; P < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P > 0.05) [Table 1].
Table 1: The results of the two groups' comparison

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   Discussion Top


Generally, cerebral aneurysm clipping surgery needs long-term training and lots of experience. Experienced neurosurgeons can grasp and understand the size of the aneurysm, its shape, and its surrounding structures, and the relationship between the surrounding bone, blood vessels, and nerves; they can individualize design approaches, adopt accurate security strategies to clip aneurysms according to the circumstance of the aneurysm, but the process indeed needs a lot of training of clinical surgery. They require comprehensive intracranial anatomy knowledge and a powerful ability of space imagination, and growth is also accompanied by mistakes and patient losses.[19]

After the preoperative use of the 3D printing model, we made the operation plan, designed approaches, and simulated clip strategies, the simulation undoubtedly can cut unnecessary time to expedite the operation process.[20] According to statistics comparing two patient groups who underwent surgery, the simulation group's exposure time was shorter than the conventional surgery group's, averaging 89 minutes on average. This resulted in a shorter operating time and a decrease in surgical blood loss and postoperative infection. Compared with the 22 days in the conventional surgery group, the 18 days in the simulation group were slightly shorter than that in the conventional surgery group.


   Conclusion Top


The 3D-printed aneurysm model is characterized by convenience, high simulation, practicability, and individualized production, which has high application value in making detailed surgical plans and can effectively shorten the operation time, reduce postoperative complications and reduce postoperative neurological dysfunction.

SPSS software was used for statistical analysis. Independent sample t-test was used for measurement data of normal distribution, the Mann-Whitney U test was used for measurement data of non-normal distribution, and the Chi-square test was used for counting data. P < 0.05 was considered statistically significant.

Abbreviations

3D = Three dimensions

CTA = Computed tomography angiography

STL format = Standard Tessellation Language format

NIHSS = The National Institutes of Health Stroke Scale

DSA = Digital subtraction angiography

GOS = Glasgow Outcome Scale

SLA = Stereolithography, light curing forming

Financial support and sponsorship

This work (Z171100001017044) was supported by the Capital Clinical Characteristic Application Research and Achievement Promotion Project of Beijing.

Conflict of interest

There are no conflicts of interest.



 
   References Top

1.
Mitchell P, Gholkar A, Vindlacheruvu RR, Mendelow AD. Unruptured intracranial aneurysms: Benign curiosity or ticking bomb? Lancet Neurol 2004;3:85-92.  Back to cited text no. 1
    
2.
Schaafsma JD, Sprengers ME, van Rooij WJ, Sluzewski M, Majoie CB, Wermer MJ, et al. Long-term recurrent subarachnoid hemorrhage after adequate coiling versus clipping of ruptured intracranial aneurysms. Stroke 2009;40:1758-63.  Back to cited text no. 2
    
3.
Lanzino G, Fraser K, Kanaan Y, Wagenbach A. Treatment of ruptured intracranial aneurysms since the International Subarachnoid Aneurysm Trial: Practice utilizing clip ligation and coil embolization as individual or complementary therapies. J Neurosurg 2006;104:344-9.  Back to cited text no. 3
    
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Lawton MT, Quinones-Hinojosa A, Sanai N, Malek JY, Dowd CF. Combined microsurgical and endovascular management of complex intracranial aneurysms. Neurosurgery 2003;52:263-74; discussion 274-5.  Back to cited text no. 4
    
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Cezar-Junior AB, Viturino U, Vieira de Carvalho EJ, Faquini IV, Almeida NS, Azevedo-Filho HRC. Blister aneurysms of the internal carotid artery: Surgical treatment and management outcome from a single center experience. Clin Neurol Neurosurg 2019;182:136-41.  Back to cited text no. 5
    
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Liaw CY, Guvendiren M. Current and emerging applications of 3D printing in medicine. Biofabrication 2017;9:024102.  Back to cited text no. 6
    
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Haleem A, Javaid M, Khan RH, Suman R. 3D printing applications in bone tissue engineering. J Clin Orthop Trauma 2020;11(Suppl 1):S118-24.  Back to cited text no. 7
    
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Ma Y, Xie L, Yang B, Tian W. Three-dimensional printing biotechnology for the regeneration of the tooth and tooth-supporting tissues. Biotechnol Bioeng 2019;116:452-68.  Back to cited text no. 8
    
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Lee SJ, Heo DN, Park JS, Kwon SK, Lee JH, Lee JH, et al. Characterization and preparation of bio-tubular scaffolds for fabricating artificial vascular grafts by combining electrospinning and a 3D printing system. Phys Chem Phys 2015;17:2996-9.  Back to cited text no. 9
    
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Colunga T, Dalton S. Building blood vessels with vascular progenitor cells. Trends Mol Med 2018;24:630-41.  Back to cited text no. 10
    
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Frolich AM, Spallek J, Brehmer L, Buhk JH, Krause D, Fiehler J, et al. 3D Printing of intracranial aneurysms using fused deposition modeling offers highly accurate replications. AJNR Am J Neuroradiol 2016;37:120-4.  Back to cited text no. 11
    
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Garcia J, Yang Z, Mongrain R, Leask RL, Lachapelle K. 3D printing materials and their use in medical education: A review of current technology and trends for the future. BMJ Simul Technol Enhanc Learn 2018;4:27-40.  Back to cited text no. 12
    
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Tam MD, Laycock SD, Brown JR, Jakeways M. 3D printing of an aortic aneurysm to facilitate decision making and device selection for endovascular aneurysm repair in complex neck anatomy. J Endovasc Ther 2013;20:863-7.  Back to cited text no. 13
    
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Wurm G, Lehner M, Tomancok B, Kleiser R, Nussbaumer K. Cerebrovascular biomodeling for aneurysm surgery: simulation-based training by means of rapid prototyping technologies. Surg Innov 2011;18:294-306.  Back to cited text no. 14
    
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Waran V, Narayanan V, Karuppiah R, Owen SL, Aziz T. Utility of multimaterial 3D printers in creating models with pathological entities to enhance the training experience of neurosurgeons. J Neurosurg 2014;120:489-92.  Back to cited text no. 15
    
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Blaszczyk M, Jabbar R, Szmyd B, Radek M. 3D Printing of rapid, low-cost and patient-specific models of brain vasculature for use in preoperative planning in clipping of intracranial aneurysms. J Clin Med 2021;10:1201.  Back to cited text no. 16
    
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Chen PC, Lin JC, Chiang CH, Chen YC, Chen JE, Liu WH. Engineering additive manufacturing and molding techniques to create lifelike willis' circle simulators with aneurysms for training neurosurgeons. Polymers (Basel) 2020;12:2901.  Back to cited text no. 17
    
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Faraj MK, Hoz SS, Mohammad AJ. The use of three-dimensional anatomical patient-specific printed models in surgical clipping of intracranial aneurysm: A pilot study. Surg Neurol Int 2020;11:381.  Back to cited text no. 18
    
19.
Joseph FJ, Weber S, Raabe A, Bervini D. Neurosurgical simulator for training aneurysm microsurgery-A user suitability study involving neurosurgeons and residents. Acta Neurochir (Wien) 2020;162:2313-21.  Back to cited text no. 19
    
20.
Lan Q, Zhu Q, Xu L, Xu T. Application of 3D-printed craniocerebral model in simulated surgery for complex intracranial lesions. World Neurosurg 2020;134:e761-70.  Back to cited text no. 20
    


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