Cranioplasty: 3D printing application for skull plastics in Russia
Last year, we talked about the use of industrial 3D printing in medicine to create an active prosthetic fingers . Yes, and more and more stories about the use of 3D printing in the medical field appear on the Internet: 3D printing of biomaterials is being developed, technology is used in dentistry, replicas of human organs are printed, which help to carefully plan and properly plan successful operations. It is about the last application of 3D printing in medicine, to which we have put our hand, I will tell today. Under the cat you will find a description of the patient's history, the process of processing DICOM files and a photograph of the operation itself on the skull.
Trauma history
It all started in 2010. A two-year-old boy named Lesha ran home, fell, hitting the back of his head on a plinth, punched his head. An ambulance team delivered Lesha first to the district hospital of the Moscow region, from where he was transported to the Research Institute of Emergency Pediatric Surgery and Traumatology (SRI NDHi) with the assistance of the territorial center of emergency medicine for emergency mobiles.
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Since the condition was severe, the child was urgently sent to CT of the head, which revealed spontaneous intracerebral hemorrhage in the depths of the left temporal lobe, diffuse swelling of both hemispheres, compression of the cerebrospinal spaces and displacement of the median structures, descending insertion at the level of the cerebellum and the large occipital foramen - the injury was serious. In an emergency order, craniotomy was performed with removal of intracerebral hematoma, dura mater plastics, in which a titanium plate and a child's own bone were used to “patch up” the hole. An installation of a sensor measuring intracranial pressure was also performed. Then a long period of treatment followed, on January 6, 2011, Lesha was finally discharged in a satisfactory condition and went home. He had to be monitored regularly at the Consultative and Diagnostic Center of the Research Institute NDHiT.
In November 2014, the boy’s mother complained that the bone flap, which covered the brain, had become mobile. After contacting the consultative and diagnostic department of the scientific research institute NDHiT, the child was hospitalized for re-plastics of the skull defect.
Skull Replica and 3D Printing
Since the skull is an anatomically closed system, for its proper functioning, the mobility of the bone flap, which partially absorbed with time, must be eliminated. Typically, such an operation lasts more than one hour, doctors have to simulate the plate along the way, relying only on CT data, which means that for a long time the child’s skull will be trepanned, which entails certain risks.
In order to carry out preoperative modeling of the plate, a skull replica was required. She will allow in volume to see area which will undergo repeated intervention. Thanks to 3D printing, it became possible to create a three-dimensional model of the child’s skull in a short time.
Use KT images to create a 3D model.
3D modeling from computed tomography (CT) data was the first step in creating a skull replica. Also for this work would be suitable images of magnetic resonance imaging (MRI).
We had a complete set of CT images in the DICOM format on our hands, a solid-state 3D model was to be made of them.
First, a mask was made on CT, on the basis of which a 3D model was generated.
This screenshot shows that some of the fragments of the skull are “suspended” in the air. If for physicians the position of the fragments was significant, then at the 3D printing stage we would apply the stereolithography technology (DLP). This technology involves the use of material support, and to maintain the "suspension" of bone pieces, supporting structures would simply not be removed. But since this was not required by the doctors, we removed all the excess and “cleaned up” the 3D model.
Since we were going to print the skull from gypsum (full-color sandstone or gypsum polymer), the 3D model was first adapted to the characteristics of this material. In particular, it was necessary to comply with the wall thickness, so that when it comes out of the printer, it does not fall apart.
Preoperative plate modeling
As soon as the 3D model was ready, tested and re-checked, the printing phase began. We tried as quickly as possible to print the skull, the whole process of modeling and printing took about a day. As soon as the technologists gave the go-ahead, the skull was promptly taken to the clinic and transferred to the doctors. The finished skull looked like this:
The titanium plate was modeled before the operation:
Everything is ready, it's time for surgery.
The operation was crowned with success; it was exciting, interesting and inspiring to lend a hand to it.
Advantages of using 3D printing for cranioplasty
Bright 3D future
This is not the last way to use 3D printing in this area, and if you are interested, I will definitely share with you new stories and not only medical ones.
In general, reading articles on additive technologies, especially in Runet, you can meet different views on these technologies. As admired, attributing 3D prints are impossible pluses, so are purely negative “Luddites” looks. As a person working with this technology every day, I can say that it really opens up new horizons for us, we just need to apply it correctly.
ps While the post was hanging here, a couple of people have already written who will have similar operations on the skull, and they want doctors to prepare in a similar way for their operations to reduce the time of the operation itself and increase the chances of success. I wonder why the doctors do not offer such an option to prepare their patients, or am I mistaken and these are isolated cases? Maybe just not all doctors know that this is possible in Russia?
Trauma history
It all started in 2010. A two-year-old boy named Lesha ran home, fell, hitting the back of his head on a plinth, punched his head. An ambulance team delivered Lesha first to the district hospital of the Moscow region, from where he was transported to the Research Institute of Emergency Pediatric Surgery and Traumatology (SRI NDHi) with the assistance of the territorial center of emergency medicine for emergency mobiles.
')
Since the condition was severe, the child was urgently sent to CT of the head, which revealed spontaneous intracerebral hemorrhage in the depths of the left temporal lobe, diffuse swelling of both hemispheres, compression of the cerebrospinal spaces and displacement of the median structures, descending insertion at the level of the cerebellum and the large occipital foramen - the injury was serious. In an emergency order, craniotomy was performed with removal of intracerebral hematoma, dura mater plastics, in which a titanium plate and a child's own bone were used to “patch up” the hole. An installation of a sensor measuring intracranial pressure was also performed. Then a long period of treatment followed, on January 6, 2011, Lesha was finally discharged in a satisfactory condition and went home. He had to be monitored regularly at the Consultative and Diagnostic Center of the Research Institute NDHiT.
In November 2014, the boy’s mother complained that the bone flap, which covered the brain, had become mobile. After contacting the consultative and diagnostic department of the scientific research institute NDHiT, the child was hospitalized for re-plastics of the skull defect.
Skull Replica and 3D Printing
Since the skull is an anatomically closed system, for its proper functioning, the mobility of the bone flap, which partially absorbed with time, must be eliminated. Typically, such an operation lasts more than one hour, doctors have to simulate the plate along the way, relying only on CT data, which means that for a long time the child’s skull will be trepanned, which entails certain risks.
In order to carry out preoperative modeling of the plate, a skull replica was required. She will allow in volume to see area which will undergo repeated intervention. Thanks to 3D printing, it became possible to create a three-dimensional model of the child’s skull in a short time.
Use KT images to create a 3D model.
3D modeling from computed tomography (CT) data was the first step in creating a skull replica. Also for this work would be suitable images of magnetic resonance imaging (MRI).
We had a complete set of CT images in the DICOM format on our hands, a solid-state 3D model was to be made of them.
First, a mask was made on CT, on the basis of which a 3D model was generated.
This screenshot shows that some of the fragments of the skull are “suspended” in the air. If for physicians the position of the fragments was significant, then at the 3D printing stage we would apply the stereolithography technology (DLP). This technology involves the use of material support, and to maintain the "suspension" of bone pieces, supporting structures would simply not be removed. But since this was not required by the doctors, we removed all the excess and “cleaned up” the 3D model.
Since we were going to print the skull from gypsum (full-color sandstone or gypsum polymer), the 3D model was first adapted to the characteristics of this material. In particular, it was necessary to comply with the wall thickness, so that when it comes out of the printer, it does not fall apart.
Preoperative plate modeling
As soon as the 3D model was ready, tested and re-checked, the printing phase began. We tried as quickly as possible to print the skull, the whole process of modeling and printing took about a day. As soon as the technologists gave the go-ahead, the skull was promptly taken to the clinic and transferred to the doctors. The finished skull looked like this:
The titanium plate was modeled before the operation:
Everything is ready, it's time for surgery.
Photos of the operation itself (better not to look impressionable):
The operation was crowned with success; it was exciting, interesting and inspiring to lend a hand to it.
Advantages of using 3D printing for cranioplasty
- Improving the accuracy of diagnosis
- accurate planning of the operation
- reduction of surgery time
- convenience of storing data in a digital format (if necessary, you can always refer to the 3D model and print it again)
Bright 3D future
This is not the last way to use 3D printing in this area, and if you are interested, I will definitely share with you new stories and not only medical ones.
In general, reading articles on additive technologies, especially in Runet, you can meet different views on these technologies. As admired, attributing 3D prints are impossible pluses, so are purely negative “Luddites” looks. As a person working with this technology every day, I can say that it really opens up new horizons for us, we just need to apply it correctly.
ps While the post was hanging here, a couple of people have already written who will have similar operations on the skull, and they want doctors to prepare in a similar way for their operations to reduce the time of the operation itself and increase the chances of success. I wonder why the doctors do not offer such an option to prepare their patients, or am I mistaken and these are isolated cases? Maybe just not all doctors know that this is possible in Russia?
Source: https://habr.com/ru/post/374923/
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