World Neurosurg. 2021 Aug 24:S1878-8750(21)01256-0. doi: 10.1016/j.wneu.2021.08.080. Online ahead of print.
ABSTRACT
BACKGROUND: Endoscopic transnasal transclival intradural surgery is limited by a high postoperative cerebrospinal fluid leak rate.
OBJECTIVE: To investigate the role of 3D printing to create a personalized, rigid scaffold for clival reconstruction.
METHODS: Two different types of clivectomy were performed in 5 specimens, with the aid of neuronavigation, and 11 clival reconstructions were simulated. They were repaired with polylactide, 3D-printed scaffolds, manually designed in a computer-aided environment either on the real or the predicted defect. Scaffolds were printed with a fused filament fabrication technique and different offsets. They were positioned and fixed either following the gasket seal technique or with screws. Post-dissection radiological evaluation of scaffold position was performed in all cases. In three specimens, the CSF leak pressure point was measured immediately after reconstruction.
RESULTS: The production process took approximately 30 hours. The designed scaffolds were satisfactory when no offset was added. Wings were added during the design to allow for screw positioning, but broke in 30% of cases. Radiological assessment documented an extreme accuracy of scaffold positioning when the scaffold was created on the real defect; it was satisfactory when the predicted clivectomy was performed under neuronavigation guidance. The CSF leak pressure point was significantly higher when the scaffold was fixed with screws as compared to the gasket technique.
CONCLUSIONS: Additive manufacturing allows the creation of customized scaffolds that are effective, in this preclinical setting, in reconstructing even large and geometrically complex clival defects.
PMID:34450324 | DOI:10.1016/j.wneu.2021.08.080
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