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Patient-specific 3D printing guide for single-stage skull bone tumor surgery: Novel software workflow with manufacturing of pre-fabricated jigs for bone resection and reconstruction

PurposeThe purpose of this study was to describe a novel system workflow to design and manufacture patient-specific 3D printing jigs for single-stage skull bone tumor excision and reconstruction, and to present the surgical outcomes of 14 patients.MethodsA specific computer aided design (CAD)/ computer aided manufacturing (CAM) software and hardware system was set up, it includes a virtual surgical planning subsystem and a 3D-printing associated manufacturing subsystem. Computed tomography (CT) data of patient’s skull are used for 3D rendering of the skull and tumor. The output of patient specific designing includes a 3D printing guide for tumor resection, and a 3D printing model of the bone defect after excision of tumor. A polymethyl methacrylate (PMMA) implant is fabricated preoperatively and used for repair.ResultsThe specific 3D printing guide was used to design intraoperative jigs and implants for 14 patients (aged 1 to 72 years) with skull bone tumors. In all cases, the cutting jig allowed precise excision of tumor and bone, and implants were exact fits for the deficits created. All operative results were successful, without intraoperative or postoperative complications. Post-operative CT scans were attained for analysis The post-operative three-dimensional measurement of the skull symmetry index ( cranial vault asymmetry index ; CVAI) show significantly improvement of the head contour after operation.ConclusionsThe CAD/CAM system described allows definitive preoperative planning and fabrication for the treatment of skull bone tumors. Apparent benefits of the method include more accurate determination of surgical margins and better oncological outcomes.


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