Interdisciplinary Neurosurgery (Jun 2021)
Use of three-dimensional reconstruction in 3D molds as an adjuvant in the treatment of cranial and spinal pathologies: Technical details and case report
Abstract
Background: The use of 3D printing in treatment of cranial and spinal pathologies has given rise to investigation of its utility as practical and anatomically precise methods. In this investigation we review this utility of three-dimensional molds for surgical planning and pathological comprehension in the neurosurgical field; also, it’s affordable/price comparability to other synthetic competitors in the market. Case series and methods: Case report based on the retrospective analysis of the medical record and complementary exams of the patient associated with a literature review of indexed databases MEDLINE, LILACS, SciElo, BIREME, Scopus, PubMED, Cochrane Library. Case report – Patient 1: Clinical History and Physical Exam: Caucasian female patient, 36 years old, outpatient with multiple intracranial meningiomas has been evolving with a depressive syndrome in the last 4 months due to aesthetic defect by progressive left eye proptosis associated to diagnosis of spheno-orbital meningioma. Physical examination revealed unilateral left proptosis associated with craniofacial deformity, without alterations in the right eye. Neuroimaging Investigation: In the complementary investigation by CT and MRI, there was evidence of extra-axial tumor with contrast uptake, located in the left sphenoid wing region and invading orbital components and cavernous sinus. Surgical Procedure: Due to the clinical findings and the progressive increase of the orbital mass, the surgical approach (left frontotemporal craniotomy associated with resection of the roof and lateral wall of the left orbit) was adopted to resect the tumour, aiming at correcting the deformity and protecting against further invasion of the optic nerve canal. It was performed a subtotal resection of the meningioma (chordoid pattern, grade II) with total exeresis of orbital components and parcial resection of the cavernous and sphenoid tumoral components. After the resection a three-dimensional printed cast) of the patient's orbit was used for titanium mesh reconstruction, resulting in reduced surgical time and better aesthetic and functional outcome for the patient. Case report – patient 2: Clinical History: Patient with achondroplasia (dwarfism), that over past 2 years has had developing chronic and progressive neurogenic lameness associated with severe bilateral L2 to S1 multiradiculopathy due to congenital medullary stenosis of the lumbar spine and severe foraminal stenosis from levels L2 to S1 (bilateral). Primary Surgical Procedure: Partial central laminectomy without foraminal decompression undergone in another institution which evolved into progressive worsening of ambulation. Primary Postoperative: At initial consultation after primary operation had grade II lower limb reflexes, generalized lower limb weakness and grade II crural paraparesis. Secondary Surgical Procedure: spinal decompression through total laminectomy associated with facetectomy due to severe congenital lumbar multiforaminal stenosis from L2 to S1 was performed. Three-Dimensional Lumbosacral Impressions: To increase safety and decrease possibility of lesion to the spinal cord and intraoperative nerves, a 3D cast of the patient's lumbosacral spine was made for pathological evaluation and surgical planning of secondary surgical procedure. Method, materials and prices – Comparisons: The 3D impression was made from Polylactic Acid (PLA), Acrylonitrile Butadiene Styrene (ABS) and Fused Deposition Modelling Plastics (FDM). The cost underlying the use of these materials are highly inexpensive (£67) compared to 3D prostheses directly implanted in the head (£3850). Conclusion: The use of three-dimensional impressions in cases with cranial and spinal pathologies has demonstrated exceptional results according to the author’s experience. Thus, this assay serves as a potential tool to optimize surgical planning as well as provide a cheaper alternative to improve both functional and aesthetic postoperative outcomes in similar cases.
