J Neurol Surg B Skull Base 2016; 77(03): 243-248
DOI: 10.1055/s-0035-1566253
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Individualized Surgical Approach Planning for Petroclival Tumors Using a 3D Printer

Thomas John Muelleman
1   Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, United States
,
Jeremy Peterson
2   Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, United States
,
Naweed Iffat Chowdhury
1   Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, United States
,
Jason Gorup
2   Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, United States
,
Paul Camarata
2   Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, United States
,
James Lin
2   Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, United States
› Institutsangaben
Weitere Informationen

Publikationsverlauf

02. Juni 2015

16. September 2015

Publikationsdatum:
03. November 2015 (online)

Abstract

Objectives To determine the utility of three-dimensional (3D) printed models in individualized petroclival tumor resection planning by measuring the fidelity of printed anatomical structures and comparing tumor exposure afforded by different approaches.

Design Case series and review of the literature.

Setting Tertiary care center.

Participants Three patients with petroclival lesions.

Main Outcome Measures Subjective opinion of access by neuro-otologists and neurosurgeons as well as surface area of tumor exposure.

Results Surgeons found the 3D models of each patient's skull and tumor useful for preoperative planning. Limitations of individual surgical approaches not identified through preoperative imaging were apparent after 3D models were evaluated. Significant variability in exposure was noted between models for similar or identical approaches. A notable drawback is that our printing process did not replicate mastoid air cells.

Conclusions We found that 3D modeling is useful for individualized preoperative planning for approaching petroclival tumors. Our printing techniques did produce authentic replicas of the tumors in relation to bony structures.

 
  • References

  • 1 Campbell E, Whitfield RD. Posterior fossa meningiomas. J Neurosurg 1948; 5 (2) 131-153
  • 2 Yasargil MG, Mortara RW, Curcic M. Meningiomas of basal posterior cranial fossa. In: Kraynbuhl H, ed. Advances and Technical Standards in Neurosurgery. Vienna, Austria: Springer; 1980: 1-115
  • 3 Xu F, Karampelas I, Megerian CA, Selman WR, Bambakidis NC. Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results. Neurosurg Focus 2013; 35 (6) E11
  • 4 Al-Mefty O, Fox JL, Smith RR. Petrosal approach for petroclival meningiomas. Neurosurgery 1988; 22 (3) 510-517
  • 5 Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery 1991; 28 (6) 869-875 ; discussion 875–876
  • 6 Seifert V, Raabe A, Zimmermann M. Conservative (labyrinth-preserving) transpetrosal approach to the clivus and petroclival region—indications, complications, results and lessons learned. Acta Neurochir (Wien) 2003; 145 (8) 631-642 ; discussion 642
  • 7 Brandt MG, Poirier J, Hughes B, Lownie SP, Parnes LS. The transcrusal approach: a 10-year experience at one Canadian center. Neurosurgery 2010; 66 (5) 1017-1022
  • 8 Xiao X, Zhang L, Wu Z , et al. Surgical resection of large and giant petroclival meningiomas via a modified anterior transpetrous approach. Neurosurg Rev 2013; 36 (4) 587-593 ; discussion 593–594
  • 9 Bambakidis NC, Kakarla UK, Kim LJ , et al. Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery 2008; 62 (6) (Suppl. 03) 1182-1191
  • 10 Nanda A, Javalkar V, Banerjee AD. Petroclival meningiomas: study on outcomes, complications and recurrence rates. J Neurosurg 2011; 114 (5) 1268-1277
  • 11 Sharma M, Ambekar S, Guthikonda B, Nanda A. A comparison between the Kawase and extended retrosigmoid approaches (retrosigmoid transtentorial and retrosigmoid intradural suprameatal approaches) for accessing the petroclival tumors. A cadaveric study. J Neurol Surg B Skull Base 2014; 75 (3) 171-176
  • 12 Ambekar S, Amene C, Sonig A, Guthikonda B, Nanda A. Quantitative comparison of retrosigmoid intradural suprameatal approach and retrosigmoid transtentorial approach: implications for tumors in the petroclival region. J Neurol Surg B Skull Base 2013; 74 (5) 300-304
  • 13 Chang SW, Wu A, Gore P , et al. Quantitative comparison of Kawase's approach versus the retrosigmoid approach: implications for tumors involving both middle and posterior fossae. Neurosurgery 2009; 64 (3, Suppl): ons44-ons51 ; discussion ons51–ons52
  • 14 Siwanuwatn R, Deshmukh P, Figueiredo EG, Crawford NR, Spetzler RF, Preul MC. Quantitative analysis of the working area and angle of attack for the retrosigmoid, combined petrosal, and transcochlear approaches to the petroclival region. J Neurosurg 2006; 104 (1) 137-142
  • 15 Little AS, Jittapiromsak P, Crawford NR , et al. Quantitative analysis of exposure of staged orbitozygomatic and retrosigmoid craniotomies for lesions of the clivus with supratentorial extension. Neurosurgery 2008; 62 (5) (Suppl. 02) ONS318-ONS323 ; discussion ONS323–ONS324
  • 16 Safavi-Abbasi S, Zabramski JM, Deshmukh P , et al. Moving toward the petroclival region: a model for quantitative and anatomical analysis of tumor shift. J Neurosurg 2007; 107 (4) 797-804
  • 17 Unger BJ, Kraut J, Rhodes C, Hochman J. Design and validation of 3D printed complex bone models with internal anatomic fidelity for surgical training and rehearsal. Stud Health Technol Inform 2014; 196: 439-445
  • 18 Jacobs S, Grunert R, Mohr FW, Falk V. 3D-Imaging of cardiac structures using 3D heart models for planning in heart surgery: a preliminary study. Interact Cardiovasc Thorac Surg 2008; 7 (1) 6-9
  • 19 Niikura T, Sugimoto M, Lee SY , et al. Tactile surgical navigation system for complex acetabular fracture surgery. Orthopedics 2014; 37 (4) 237-242
  • 20 Lueders C, Jastram B, Hetzer R, Schwandt H. Rapid manufacturing techniques for the tissue engineering of human heart valves. Eur J Cardiothorac Surg 2014; 46 (4) 593-601
  • 21 Nakayama Y, Takewa Y, Sumikura H , et al. In-body tissue-engineered aortic valve (Biovalve type VII) architecture based on 3D printer molding. J Biomed Mater Res B Appl Biomater 2015; 103 (1) 1-11
  • 22 Waran V, Narayanan V, Karuppiah R , et al. Injecting realism in surgical training--initial simulation experience with custom 3D models. J Surg Educ 2014; 71 (2) 193-197
  • 23 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 (2) 489-492
  • 24 Mavili ME, Canter HI, Saglam-Aydinatay B, Kamaci S, Kocadereli I. Use of three-dimensional medical modeling methods for precise planning of orthognathic surgery. J Craniofac Surg 2007; 18 (4) 740-747
  • 25 Jung HW, Yoo H, Paek SH, Choi KS. Long-term outcome and growth rate of subtotally resected petroclival meningiomas: experience with 38 cases. Neurosurgery 2000; 46 (3) 567-574 ; discussion 574–575
  • 26 Little KM, Friedman AH, Sampson JH, Wanibuchi M, Fukushima T. Surgical management of petroclival meningiomas: defining resection goals based on risk of neurological morbidity and tumor recurrence rates in 137 patients. Neurosurgery 2005; 56 (3) 546-559 ; discussion 546–559
  • 27 Subach BR, Lunsford LD, Kondziolka D, Maitz AH, Flickinger JC. Management of petroclival meningiomas by stereotactic radiosurgery. Neurosurgery 1998; 42 (3) 437-443 ; discussion 443–445
  • 28 Starke RM, Nguyen JH, Rainey J , et al. Gamma Knife surgery of meningiomas located in the posterior fossa: factors predictive of outcome and remission. J Neurosurg 2011; 114 (5) 1399-1409
  • 29 Zachenhofer I, Wolfsberger S, Aichholzer M , et al. Gamma-knife radiosurgery for cranial base meningiomas: experience of tumor control, clinical course, and morbidity in a follow-up of more than 8 years. Neurosurgery 2006; 58 (1) 28-36 ; discussion 28–36
  • 30 Eustacchio S, Trummer M, Fuchs I, Schröttner O, Sutter B, Pendl G. Preservation of cranial nerve function following Gamma Knife radiosurgery for benign skull base meningiomas: experience in 121 patients with follow-up of 5 to 9.8 years. Acta Neurochir Suppl (Wien) 2002; 84: 71-76