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Models and More: 3-D Printing in Neurosurgery

3-D image of a brain3-D printers have been around for a while. They’re used in industry not only to create models used in manufacturing tools and parts but also to make the parts themselves. And some printers have become affordable enough to print simple toys and other items from home.

But could they manufacture a brain?

While producing a functioning brain is a way off, the technology has found multiple uses in neurosurgery. How neurosurgeons are already using 3-D printing and how they might use the process in the future were discussed in a recent article published in the journal Biotechnology Advances.

Contributors to the article, Three-dimensional printing: technologies, applications, and limitations in neurosurgery, included senior author Dr. E. Sander Connolly and neurosurgery resident Dr. Jonathan Sisti, both of the Columbia University Medical Center/NewYork-Presbyterian Hospital.*

Dr. Connolly wears several hats at Columbia. One is Director of the Cerebrovascular Research Laboratory, which focuses on strokes and other diseases of the blood vessels of the brain.

Co-author Dr. Sisti explains: “In addition to the considerable cerebrovascular-related work conducted in Dr. Connolly’s research lab, we have strived to apply emerging technologies to the field of neurosurgery.

Some of my own work has involved utilizing mobile technologies, such as activity trackers and touchscreen tablets, to develop novel ways of prospectively following patients and automating the collection and analysis of patient-related data. Most recently, we have investigated 3D printing.”

So how does one get from a patient brain to a model brain? It usually starts with tests that physicians commonly perform on patients. For example, a patient may undergo a CT scan. The scan produces two-dimensional images of successive layers of a body part, much as one could see several “pictures” of the inside of a piece of fruit by making thin slices.

The images produced by the CT scanner are then converted to a digital computer file. Next, this information is translated to a format that can be read by a 3-D printer. Finally, the printer receives the information and is ready to start making the three-dimensional object.

While Drs. Connolly and Sisti and their colleagues note that the various types of printers differ in printing technique, cost, capabilities and precision, what the printers have in common is the ability to apply layer after layer of material to produce a three-dimensional object.

Many printers can work with multiple materials at once. This is useful in reproducing tissues with different textures, such as the brain and its surrounding blood vessels.

How can a neurosurgeon use this technology? Actually, the specialty has been using 3-D printing since 1999. A printed model can help a surgeon plan the surgical approach to an individual patient.

Individual brains and the diseases that affect them vary, and the physician’s ability to view a copy of the brain and its parts from all angles and get a tactile sense of the structures in question aids in surgical planning.

For example, for a patient needing surgery for an aneurysm, it’s possible to have a reproduction of the aneurysm itself and the surrounding blood vessels. The neurosurgeon can then think about the best approach to the surgical treatment. Since 3-D models can be manipulated with surgical instruments, surgeons are now able to actually rehearse difficult procedures in advance.

Models also form excellent learning tools. Neurosurgeons in training can hone their skills by performing procedures on the printed 3-D copies. And by viewing a 3-D model of her own brain—or even just a copy of the abnormality, such as a tumor or aneurysm—a patient can better benefit from a discussion of what will be done during a procedure.

In addition to helping neurosurgeons share information with trainees and patients, the technology has the potential to help the doctors themselves gain new knowledge. Research studies have successfully employed 3-D printed models. For example, the authors of the Biotechnology Advances article cite studies that have examined blood flow through vessels during a modeled aneurysm treatment.

New treatments, therefore, can be tested before they are tried on patients. Printers also show promise in the design and printing of patient-specific surgical tools and even living tissues that could be instrumental in treatment.

The field of 3-D printing is still in its infancy, and there are obstacles to overcome before its use becomes standard practice in medicine. Yet as Dr. Sisti points out, “As the technology matures, there are many exciting ways we can potentially utilize it to better model and understand the pathophysiology of cerebrovascular lesions.”

*Full list of authors: Josephine U. Pucci, Brandon R. Christophe, Jonathan A. Sisti, Edward S. Connolly Jr.

Read more about Dr. Connolly on his bio page here.

patient journey

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