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Volumetrically colored 3D printed models for surgical simulation and training by the example of intracranial chondrosarcomas
EANS Academy. Neulen A. 09/25/19; 275613; EP12014
Dr. Axel Neulen
Dr. Axel Neulen

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Abstract
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Background: The complete resection of tumors is essential for treatment and patient outcome. Depending on anatomical complexity this goal is often a challenging task. 3D-printing technologies offer the possibility to preoperatively simulate or train such procedures. However most 3D-printing techniques provide only monochrome or surface colored objects whereas structures nested inside each other cannot be differentiated. In this 3D-print study of cases of intracranial chondrosarcomas a modified workflow for 3D binder jetting technology is presented. It allows for volumetrically coloring 3D-prints such as vessels inside a tumor. This allows for cutting and drilling the objects, revealing internal structures of different colors.
Methods: CT and MRI data of patients were fused followed by segmentation of structures such as bone, vessels, tumor and nerves. For volumetrically coloring of specific parts their surfaces were repeatedly shrunken to generate subsurfaces in an onion shell like pattern.
The models were printed with 3D binder jetting technology (ZPrinter450, 3DSystems, Rock Hill, USA). This technique solidifies plaster based powder by partially applying binder and color onto every layer during production.
Results: CT scans of the printed models were compared to the initial data, showing a high reproduction accuracy (mean distance 0,021 mm, +/- 0.076 mm). Furthermore the plaster material showed excellent behavior while drilling and cutting without melting. The volumetrically colored models allowed for successively removing tumor and revealing a red colored blood vessel inside during a test simulation setup. Also craniotomy could be successfully performed with common surgical tools.
Conclusion: The workflow described produces volumetrically colored 3D-prints resulting in visual appealing and tangible models, which matched the original anatomy with high accuracy. Coloring objects inside a volume allows for surgical simulation of even complex configurations (vessel inside of tumor). Major drawbacks were seen in the fact of missing soft tissue to simulate e.g. brain retraction.
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