Operative simulation of anterior clinoidectomy using a rapid prototyping model molded by a three-dimensional printer

Simulation tools in neuro-oncological surgery: a scoping review of perioperative and training applications

BACKGROUND

Neuro-oncological surgery has lagged other neurosurgical subspecialties in integrating simulation technologies for training and surgical planning. This study provides a comprehensive scoping review of the current landscape of simulation tools in neuro-oncological surgery, mapping existing research, identifying technological advancements, and highlighting gaps in surgical training and perioperative planning.

METHODS

We formulated the research question: "What is the effect of perioperative simulation and neuro-oncological training on surgical skill acquisition, patient outcomes, and safety among neurosurgeons, compared to traditional or no training methods?" A comprehensive search was conducted on PubMed, Scopus and ClinicalTrials.gov, with the final search completed in May 2024. The quality of training studies was assessed using the Medical Education Research Study Quality Instrument (MERSQI), and the Cochrane ROBINS-I tool was used to evaluate bias in simulation studies.

RESULTS

The search yielded 5,518 records, with 51 studies meeting the inclusion criteria. These were categorized into six groups: (1) 3D Models in Presurgical Planning and Intraoperative Navigation: 5 articles; (2) Augmented Reality (AR) in Presurgical Planning and Intraoperative Navigation: 25 articles; (3) Mixed Reality (MR) in Presurgical Planning and Intraoperative Navigation: 6 articles; (4) Virtual Reality (VR) in Presurgical Planning and Intraoperative Navigation: 4 articles; (5) AR in Surgical Training: 5 articles; (6) VR in Surgical Training: 6 articles.

CONCLUSION

While the number of studies on simulation in neuro-oncological surgery is increasing, their analytical depth remains limited. Simulation holds promise for advancing the field, but a significant journey lies ahead before achieving universal academic validation.

Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: neurosurgical and otolaryngologic conditions

BACKGROUND

Medical three dimensional (3D) printing is performed for neurosurgical and otolaryngologic conditions, but without evidence-based guidance on clinical appropriateness. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness recommendations for neurologic 3D printing conditions.

METHODS

A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with neurologic and otolaryngologic conditions. Each study was vetted by the authors and strength of evidence was assessed according to published guidelines.

RESULTS

Evidence-based recommendations for when 3D printing is appropriate are provided for diseases of the calvaria and skull base, brain tumors and cerebrovascular disease. Recommendations are provided in accordance with strength of evidence of publications corresponding to each neurologic condition combined with expert opinion from members of the 3D printing SIG.

CONCLUSIONS

This consensus guidance document, created by the members of the 3D printing SIG, provides a reference for clinical standards of 3D printing for neurologic conditions.

Transcription Factor GLI1 Induces IL-6-Mediated Inflammatory Response and Facilitates the Progression of Adamantinomatous Craniopharyngioma

Adamantinomatous craniopharyngioma (ACP) is a neuroendocrine tumor whose pathogenesis remains unclear. This study investigated the role of glioma-associated oncogene family zinc finger 1 (GLI1), a transcription factor in the sonic hedgehog (SHH) signaling pathway, in ACP. We discovered that GLI1 regulates the expression of IL-6, thereby triggering inflammatory responses in ACP and influencing the tumor's progression. Analyzing the Gene Expression Omnibus (GEO) database chip GSE68015, we found that GLI1 is overexpressed in ACP, correlating positively with the spite of ACP and inflammation markers. Knockdown of GLI1 significantly inhibited the levels of tumor necrosis factor α, interleukin-6 (IL-6), and IL-1β in ACP cells, as well as cell proliferation and migration. We further identified a binding site between GLI1 and the promoter region of IL-6, demonstrating that GLI1 can enhance the expression of IL-6. These findings were verified in vivo, where activation of the SHH pathway significantly promoted GLI1 and IL-6 expressions in nude mice, inducing inflammation and tumor growth. Conversely, GLI1 knockdown markedly suppressed these processes. Our study uncovers a potential molecular mechanism for the occurrence of inflammatory responses and tumor progression in ACP.

3D-Printed Disease Models for Neurosurgical Planning, Simulation, and Training

Spatial insight into intracranial pathology and structure is important for neurosurgeons to perform safe and successful surgeries. Three-dimensional (3D) printing technology in the medical field has made it possible to produce intuitive models that can help with spatial perception. Recent advances in 3D-printed disease models have removed barriers to entering the clinical field and medical market, such as precision and texture reality, speed of production, and cost. The 3D-printed disease model is now ready to be actively applied to daily clinical practice in neurosurgical planning, simulation, and training. In this review, the development of 3D-printed neurosurgical disease models and their application are summarized and discussed.

3D Printing in Neurosurgery Residency Training: A Systematic Review of the Literature

BACKGROUND

The use of 3-dimensional (3D) printing in neurosurgery has become more prominent in recent years for surgical training, preoperative planning and patient-education. Several smaller studies are available using 3D printing however there is a lack of a concise review. This article provides a systematic review of current 3D models in use by neurosurgical residents with emphasis on training, learning, and simulation.

METHODS

A structured literature search of PubMed and Embase was conducted using PRISMA guidelines to identify publications specific to 3D models trialed on neurosurgical residents. Criteria for eligibility included articles discussing only neurosurgery, 3D models in neurosurgery, and models specifically tested or trialed on residents.

RESULTS

Overall a total of 40 articles were identified that met inclusion criteria. These studies encompassed different neurosurgical areas including aneurysm, spine, craniosynostosis, transsphenoidal, craniotomy, skull base, and tumor. The majority of the articles were related to brain surgery. Of these studies, vascular surgery had the highest overall with 13 out of 40 articles which include aneurysm clipping and other neurovascular surgeries. Twenty-two discussed cranial plus tumor surgeries which included skull base, craniotomy, craniosynostosis and transsphenoidal. Lastly, 5 studies were specific to spine surgeries. Subjective outcome measures of neurosurgical residents were most commonly implemented, of which results were almost unanimously positive.

CONCLUSION

3D printing technology is rapidly expanding in healthcare and neurosurgery in particular. The technology is quickly improving, and several studies have demonstrated the effectiveness of 3D printing for neurosurgical residency education and training.

Clinical application of 3D virtual and printed models for cerebrovascular diseases

OBJECTIVE

Three-dimensional (3D) printing techniques are rapidly advancing in the medical industry and in clinical practice. We aimed to evaluate the usefulness of 3D virtual and printed models of 6 representative cerebrovascular diseases using the software we developed.

METHODS

Six cases consisted of 4 intracranial aneurysms (IAs) including complex ones with intrasaccular thrombosis, large size and a skull base location; 1 cavernous malformation in the pons; and 1 arteriovenous malformation in the parietal lobe. The 3D modeling process was performed retrospectively in 3 cases and prospectively in 1 IA. Segmentation of raw data and rendering and modification for 3D virtual models were processed mostly automatically.

RESULTS

Most intracranial structures were satisfactorily made, including the skull, brain, vessels, thrombus, tentorium and major cranial nerves. Based on 3D modeling, surgical plan was changed in 1 prospective IA case. However, it was still difficult to discriminate small vessels and cranial nerves, to feel a realistic tactile sense and to directly perform presurgical simulations, such as dissection, removal, clipping and microanastomosis.

CONCLUSIONS

The 3D modeling was thought to be very helpful in experiencing the operative views from various directions in advance, in selecting an appropriate surgical approach, and in educating physicians and patients. With advancements in radiological resolution, processing techniques and material properties, 3D modeling is expected to simulate real brain tissues more closely.

Progress in the use of dental pulp stem cells in regenerative medicine

The field of tissue engineering is emerging as a multidisciplinary area with promising potential for regenerating new tissues and organs. This approach requires the involvement of three essential components: stem cells, scaffolds and growth factors. To date, dental pulp stem cells have received special attention because they represent a readily accessible source of stem cells. Their high plasticity and multipotential capacity to differentiate into a large array of tissues can be explained by its neural crest origin, which supports applications beyond the scope of oral tissues. Many isolation, culture and cryopreservation protocols have been proposed that are known to affect cell phenotype, proliferation rate and differentiation capacity. The clinical applications of therapies based on dental pulp stem cells demand the development of new biomaterials suitable for regenerative purposes that can act as scaffolds to handle, carry and implant stem cells into patients. Currently, the development of xeno-free culture media is emerging as a means of standardization to improve safe and reproducibility. The present review aims to describe the current knowledge of dental pulp stem cells, considering in depth the key aspects related to the characterization, establishment, maintenance and cryopreservation of primary cultures and their involvement in the multilineage differentiation potential. The main clinical applications for these stem cells and their combination with several biomaterials is also covered.