SpringerLink
Log in

Stereolithographic models in the interdisciplinary planning of treatment for complex intracranial aneurysms

  • Clinical Article - Vascular
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Treatment of complex intracranial aneurysms requires strategic pre-interventional or preoperative planning. In addition to modern three-dimensional (3D) rotational angiography, computed tomography angiography (CTA) or magnetic resonance angiogram (MRA), a solid, tangible 3D model may improve anatomical comprehension and treatment planning. A 3D rapid prototy** (RP) technique based on multimodal imaging data was evaluated for use in planning of treatment for complex aneurysmal configurations.

Methods

Six patients with complex aneurysms were selected for 3D RP based on CTA and 3D rotational angiography data. Images were segmented using image-processing software to create virtual 3D models. Three-dimensional rapid prototy** techniques transformed the imaging data into physical 3D models, which were used and evaluated for interdisciplinary treatment planning.

Results

In all cases, the model provided a comprehensive 3D representation of relevant anatomical structures and improved understanding of related vessels. Based on the 3D model, primary bypass surgery with subsequent reconstruction of the aneurysm was then considered advantageous in all but one patient after simulation of multiple approaches.

Conclusions

Preoperative prediction of intraoperative anatomy using the 3D model was considered helpful for treatment planning. The use of 3D rapid prototy** may enhance understanding of complex configurations in selected large or giant aneurysms, especially those pretreated with clips or coils.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

3D RA:

3D rotational angiography

3D RP:

3D rapid prototy**

CTA:

Computed tomography angiography

MCA:

Middle carotid artery

MRA:

Magnetic resonance angiogram

PCA:

Posterior cerebral artery

SRA:

Superficial temporal artery

References

  1. Winder J, Bibb R (2005) Medical rapid prototy** technologies: state of the art and current limitations for application in oral and maxillofacial surgery. J Oral Maxillofac Surg 63:1006–1015

    Article  PubMed  Google Scholar 

  2. Wurm G, Tomancok B, Pogady P, Holl K, Trenkler J (2004) Cerebrovascularstereolithographic biomodeling for aneurysm surgery. Technical note. J Neurosurg 100:139–145

    Article  PubMed  Google Scholar 

  3. Kondo K, Harada N, Masuda H, Sugo N, Terazono S, Okonogi S, Sakaeyama Y, Fuchinoue Y, Ando S, Fukushima D, Nomoto J, Nemoto M (2016) A neurosurgical simulation of skull base tumors using a 3D printed rapid prototy** model containing mesh structures. Acta Neurochir (Wein) 158:1213-1219

  4. Thawani JP, Pisapia JM, Singh N, Petrov D, Schuster JM, Hurst RW, Zager EL, Pukenas BA (2016) 3D-printed modeling of an arteriovenous malformation including blood flow. World Neurosurg 90:675-683.e2

  5. Schuknecht B (2007) High-concentration contrast media (HCCM) in CT angiography of the carotid system: impact on therapeutic decision making. Neuroradiology 49(Suppl 1):S15–26

    Article  PubMed  Google Scholar 

  6. Hanel RA, Spetzler RF (2008) Surgical treatment of complex intracranial aneurysms. Neurosurgery 62:1289–1297, discussion 1297–1289

    Article  PubMed  Google Scholar 

  7. Mordasini P, Kraehenbuehl AK, Byrne JV, Vandenberghe S, Reinert M, Hoppe H, Gralla J (2013) In vitro and in vivo imaging characteristics assessment of polymeric coils compared with standard platinum coils for the treatment of intracranial aneurysms. AJNR Am J Neuroradiol 34:2177–2183

    Article  CAS  PubMed  Google Scholar 

  8. Patel NV, Gounis MJ, Wakhloo AK, Noordhoek N, Blijd J, Babic D, Takhtani D, Lee SK, Norbash A (2011) Contrast-enhanced angiographic cone-beam CT of cerebrovascular stents: experimental optimization and clinical application. AJNR Am J Neuroradiol 32:137–144

    CAS  PubMed  Google Scholar 

  9. Hoit DA, Malek AM (2006) Fusion of three-dimensional calcium rendering with rotational angiography to guide the treatment of a giant intracranial aneurysm: technical case report. Neurosurgery 58:ONS-E173, discussion ONS-E173

    PubMed  Google Scholar 

  10. Jansen IG, Schneiders JJ, Potters WV, van Ooij P, van den Berg R, van Bavel E, Marquering HA, Majoie CB (2014) Generalized versus patient-specific inflowboundary conditions in computational fluid dynamics simulations of cerebral aneurysmal hemodynamics. AJNR Am J Neuroradiol 35:1543-1548

  11. Piotin M, Gailloud P, Bidaut L, Mandai S, Muster M, Moret J, Rufenacht DA (2003) CT angiography, MR angiography and rotational digital subtraction angiography forvolumetric assessment of intracranial aneurysms. An experimental study. Neuroradiology 45:404–409

    Article  CAS  PubMed  Google Scholar 

  12. D’Urso PS, Williamson OD, Thompson RG (2005) Biomodeling as an aid to spinal instrumentation. Spine (Phila Pa 1976) 30:2841–2845

    Article  Google Scholar 

  13. Izatt MT, Thorpe PL, Thompson RG, D’Urso PS, Adam CJ, Earwaker JW, Labrom RD, Askin GN (2007) The use of physical biomodelling in complex spinal surgery. Eur Spine J 16:1507–1518

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kimura T, Morita A, Nishimura K, Aiyama H, Itoh H, Fukaya S, Sora S, Ochiai C (2009) Simulation of and training for cerebral aneurysm clip** with 3-dimensional models. Neurosurgery 65:719–725, discussion 725–716

    Article  PubMed  Google Scholar 

  15. Sodian R, Weber S, Markert M, Loeff M, Lueth T, Weis FC, Daebritz S, Malec E, Schmitz C, Reichart B (2008) Pediatric cardiac transplantation: three-dimensional printing of anatomic models for surgical planning of heart transplantation in patients with univentricular heart. J Thorac Cardiovasc Surg 136:1098–1099

    Article  PubMed  Google Scholar 

  16. D’Urso PS, Thompson RG, Atkinson RL, Weidmann MJ, Redmond MJ, Hall BI, Jeavons SJ, Benson MD, Earwaker WJ (1999) Cerebrovascular biomodelling: a technical note. Surg Neurol 52:490–500

    Article  PubMed  Google Scholar 

  17. Mashiko T, Otani K, Kawano R, Konno T, Kaneko N, Ito Y, Watanabe E (2015) Development of three-dimensional hollow elastic model for cerebral aneurysm clip** simulation enabling rapid and low cost prototy**. World Neurosurg 83:351–361

    Article  PubMed  Google Scholar 

  18. Perez-Arjona E, Dujovny M, Park H, Kulyanov D, Galaniuk A, Agner C, Michael D, Diaz FG (2003) Stereolithography: neurosurgical and medical implications. Neurol Res 25:227–236

    Article  PubMed  Google Scholar 

  19. Ryan JR, Almefty KK, Nakaji P, Frakes DH (2016) Cerebral aneurysm clip** surgery simulation using patient-specific 3D printing and silicone casting. World Neurosurg 88:175–181

    Article  PubMed  Google Scholar 

  20. Wurm G, Lehner M, Tomancok B, Kleiser R, Nussbaumer K (2011) Cerebrovascular biomodeling for aneurysm surgery: simulation-based training by means of rapid prototy** technologies. Surg Innov 18:294–306

    Article  PubMed  Google Scholar 

  21. Russin J, Babiker H, Ryan J, Rangel-Castilla L, Frakes D, Nakaji P (2015) Computational fluid dynamics to evaluate the management of a giant internal carotid artery aneurysm. World neurosurg 83:1057–1065

    Article  PubMed  Google Scholar 

  22. Arriaga AF, Bader AM, Wong JM, Lipsitz SR, Berry WR, Ziewacz JE, Hepner DL, Boorman DJ, Pozner CN, Smink DS, Gawande AA (2013) Simulation-based trial of surgical-crisis checklists. N Engl J Med 368:246–253

    Article  CAS  PubMed  Google Scholar 

  23. Arriaga AF, Gawande AA, Raemer DB, Jones DB, Smink DS, Weinstock P, Dwyer K, Lipsitz SR, Peyre S, Pawlowski JB, Muret-Wagstaff S, Gee D, Gordon JA, Cooper JB, Berry WR (2014) Pilot testing of a model for insurer-driven, large-scale multicenter simulation training for operating room teams. Ann Surg 259:403–410

    Article  PubMed  Google Scholar 

  24. Khan IS, Kelly PD, Singer RJ (2014) Prototy** of cerebral vasculature physical models. Surg Neurol Int 5:11

    Article  PubMed  PubMed Central  Google Scholar 

  25. Waran V, Narayanan V, Karuppiah R, Owen SL, Aziz T (2014) Utility of multimaterial 3D printers in creating models with pathological entities to enhance the training experience of neurosurgeons. J Neurosurg 120:489–492

    Article  PubMed  Google Scholar 

  26. Agarwal N, Chaudhari A, Hansberry DR, Tomei KL, Prestigiacomo CJ (2013) A comparative analysis of neurosurgical online education materials to assess patient comprehension. J Clin Neurosci 20:1357–1361

    Article  PubMed  Google Scholar 

  27. King JT Jr, Yonas H, Horowitz MB, Kassam AB, Roberts MS (2005) A failure to communicate: patients with cerebral aneurysms and vascular neurosurgeons. J Neurol Neurosurg Psychiatry 76:550–554

    Article  PubMed  PubMed Central  Google Scholar 

  28. Weinstock P, Prabhu SP, Flynn K, Orbach DB, Smith E (2015) Optimizingcerebrovascular surgical and endovascular procedures in children via personalized 3D printing. J Neurosurg Pediatr 31:1–6

Download references

Acknowledgements

The assistance of Ms. Susan Kaplan in editing the manuscript is acknowledged.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of Bern, Inselspital, Bern, Switzerland

    Lukas Andereggen, Robert H. Andres, Jürgen Beck, Hans Rudolf Widmer & Andreas Raabe

  2. Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland

    Lukas Andereggen, Jan Gralla & Gerhard Schroth

  3. Department of Neurosurgery and F.M. Kirby Neurobiology Centre, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Lukas Andereggen

  4. Department of Neurosurgery, Neurocenter of Southern Switzerland, 6930, Lugano, Switzerland

    Michael Reinert

  5. ARTORG Centre for Biomedical Engineering Research, University of Bern, Bern, Switzerland

    Stefan Weber & Matthias Peterhans

Authors
  1. Lukas Andereggen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan Gralla
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert H. Andres
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gerhard Schroth
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jürgen Beck
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hans Rudolf Widmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michael Reinert
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Andreas Raabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Matthias Peterhans
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Reinert.

Ethics declarations

Funding

No funding was received for this research.

Conflict of Interest

All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants fulfilled the requirements of the Ethical Committee of Bern, Switzerland (Kantonale Ethikkomission Bern, KEK) and were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

All patients provided informed consent.

Competing interests/financial disclosure

This work or part of this work has not been previously published. The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Ethical standards and patient consent

This study fulfilled the requirements of the local Ethical Committees of Bern, Switzerland.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Andereggen, L., Gralla, J., Andres, R.H. et al. Stereolithographic models in the interdisciplinary planning of treatment for complex intracranial aneurysms. Acta Neurochir 158, 1711–1720 (2016). https://doi.org/10.1007/s00701-016-2892-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-016-2892-3

Keywords

Search

Navigation