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Original Investigation
July 2018

Assessment of a Patient-Specific, 3-Dimensionally Printed Endoscopic Sinus and Skull Base Surgical Model

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of California, Davis Medical Center, Sacramento
  • 2Veterans Affairs Northern California Healthcare System, Sacramento
JAMA Otolaryngol Head Neck Surg. 2018;144(7):574-579. doi:10.1001/jamaoto.2018.0473
Key Points

Question  Is it feasible to create patient-specific, 3-dimensionally printed sinus and skull base models that are anatomically accurate and provide realistic haptic feedback comparable to cadaveric models?

Findings  In this study, 7 otolaryngology residents and 2 attending physicians evaluated the haptic feedback of a patient-specific, 3-dimensionally printed model and confirmed its anatomical accuracy with computed tomography and intraoperative navigation. The model scored high on the Likert scale for haptic accuracy with intranasal instruments.

Meaning  Three-dimensionally printed sinus and skull base models can be generated with anatomical and haptic accuracy and are potentially useful in surgical planning and as a supplemental or alternative simulation or training platform to cadaveric dissection.

Abstract

Importance  Three-dimensional (3D) printing is an emerging tool in the creation of anatomical models for simulation and preoperative planning. Its use in sinus and skull base surgery has been limited because of difficulty in replicating the details of sinus anatomy.

Objective  To describe the development of 3D-printed sinus and skull base models for use in endoscopic skull base surgery.

Design, Setting, and Participants  In this single-center study performed from April 1, 2017, through June 1, 2017, a total of 7 otolaryngology residents and 2 attending physicians at a tertiary academic center were recruited to evaluate the procedural anatomical accuracy and haptic feedback of the printed model.

Interventions  A 3D model of sinus and skull base anatomy with high-resolution, 3D printed material (VeroWhite) was printed using a 3D printer. Anatomical accuracy was assessed by comparing a computed tomogram of the original patient with that of the 3D model across set anatomical landmarks (eg, depth of cribriform plate). Image-guided navigation was also used to evaluate accuracy of 13 surgical landmarks. Likert scale questionnaires (1 indicating strongly disagree; 2, disagree; 3, neutral; 4, agree; and 5, strongly agree) were administered to 9 study participants who each performed sinus and skull base dissections on the 3D-printed model to evaluate anatomical accuracy and haptic feedback.

Main Outcomes and Measures  Main outcomes of the study include objective anatomical accuracy through imaging and navigation and haptic evaluation by the study participants.

Results  Seven otolaryngology residents (3 postgraduate year [PGY]-5 residents, 2 PGY-4 residents, 1 PGY-3 resident, and 1 PGY-2 resident) and 2 attending physicians evaluated the haptic feedback of the 3D model. Computed tomographic comparison demonstrated a less than 5% difference between patient and 3D model measurements. Image-guided navigation confirmed accuracy of 13 landmarks to within 1 mm. Likert scores were a mean (SD) of 4.00 (0.71) for overall procedural anatomical accuracy and 4.67 (0.5) for haptic feedback.

Conclusions and Relevance  This study shows that high-resolution, 3D-printed sinus and skull base models can be generated with anatomical and haptic accuracy. This technology has the potential to be useful in surgical training and preoperative planning and as a supplemental or alternative simulation or training platform to cadaveric dissection.

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