Date Published: August 6, 2020
Publisher: Springer International Publishing
Author(s): Petrice M. Cogswell, Matthew A. Rischall, Amy E. Alexander, Hunter J. Dickens, Giuseppe Lanzino, Jonathan M. Morris.
In recent years, three-dimensional (3D) printing has been increasingly applied to the intracranial vasculature for patient-specific surgical planning, training, education, and research. Unfortunately, though, much of the prior literature regarding 3D printing has focused on the end-product and not the process. In addition, for 3D printing/manufacturing to occur on a large scale, challenges and bottlenecks specific to each modeled anatomy must be overcome.
In this review article, limitations and considerations of each 3D printing processing step, as they relate to printing individual intracranial vasculature models and providing an active clinical service for a quaternary care center, are discussed. Relevant advantages and disadvantages of the available acquisition techniques (computed tomography, magnetic resonance, and digital subtraction angiography) are reviewed. Specific steps in segmentation, processing, and creation of a printable file may impede the workflow or degrade the fidelity of the printed model and are, therefore, given added attention. The various available printing techniques are compared with respect to printing the intracranial vasculature. Finally, applications are discussed, and a variety of example models are shown.
In this review we provide insight into the manufacturing of 3D models of the intracranial vasculature that may facilitate incorporation into or improve utility of 3D vascular models in clinical practice.
Over the past several years, three-dimensional (3D) printing has markedly increased in prevalence  and has been applied to the intracranial vasculature for various applications, including patient-specific models, training and education, and studying hemodynamics [2–6]. The modeled pathologies include intracranial aneurysms, vascular malformations, stenosis, and vessels as they relate to a tumor [2–4, 7, 8]. As such, patients, trainees, and providers, including neuro-interventionalists, neurosurgeons, and neurologists, benefit from the use of such models.
Printing of intracranial vasculature in 3D may be utilized for multiple applications, including patient-specific models, training, and education. For 3D printing to be implemented as a clinical service, the DSA, MRA, or CTA acquisition must be optimized to allow for accurate and efficient segmentation. In preparing the CAD files for printing the model, one must consider how each step in the process will affect the model’s accuracy and the ability to print. Finally, the appropriate printing technology and material must be chosen to best fit the desired application. In reviewing these processes, we provide insight into the manufacturing of 3D models of the intracranial vasculature that may facilitate incorporation into or improve utility of 3D vascular models in clinical practice.