Planning of Vestibular Schwannoma Surgery Using Three-Dimensional Models

Introduction: Vestibular schwannoma surgery is complex and may present with several pitfalls. Preoperative planning and the understanding of the anatomical variations in each case is a fundamental step for good results and avoidance of complications. Drilling of the internal auditory canal is, in most cases, indispensable to achieve complete tumor resection.

Objective: To evaluate the feasibility and possible advantages of the use of 3-dimensional models of temporal bone for the preoperative planning of vestibular schwannoma surgeries.

Methods: Patients with vestibular schwannomas and anatomical variations that could represent difficulties during surgery were selected for this study. After acquiring fine-cut computed tomography scans, 3-dimensional models of the temporal bone of each case using rapid prototyping technique were created. Anatomical aspects as the position of the jugular bulb and semicircular canals in relation to the internal auditory canal and the safe bone removal were evaluated.

Results: The 3-dimensional temporal bone models helped to better understand the anatomy around the internal auditory canal previously to surgery. This technique enabled an improved comprehension of the relations between the jugular bulb and semicircular canals and to plan the opening of the internal auditory canal. These models could be produced at an average price of US$ 120 each and took about one day to be fabricated.

Conclusion: Production of 3-dimensional temporal bone models previous to vestibular schwannoma surgeries using rapid prototyping technology was possible and permitted a better understanding of anatomical variations in each case. This technique helps to optimize the drilling of the internal auditory canal and may thus prevent injury of the jugular bulb and semicircular canals.