Authors :
Presenting Author: Keisuke Ohtani, MD,PhD. – JIchi medical university
Makoto SATO, MD.PhD – Jichi medical university; Yohei ISHISHITA, MD.PhD – JIchi medical university; Kenji IBAYASHI, MD.PhD – Jichi medical university; Naoto KUNII, MD.PhD – Jichi medical university; Takeshi NAKAJIMA, MD.Phd – Jichi medical university; Toshihiro MASHIKO, MD.PhD – Jichi medical university; Kensuke KAWAI, MD.PhD – professor, neurosurgery, Jichi medical university
Rationale:
Due to the lack of facilities in Japan, it is difficult for neurosurgeons to gain experience in SEEG (stereotactic intracranial electroencephalography) using a robotic system on actual patients. Aiming to acquire safer surgical techniques, we created a 3D head model using actual patient data and performed a surgical simulation. Here, we report two cases of preoperative evaluation using the head model.
Methods:
The subject of this study was two SEEG cases operated with a robotic system (Zimmer Biomet ROSA One) since March 2022 at Jichi Medical University Hospital. 3D images of patient heads were created from CT data with visualization and measurement software (Amira®). Then, a full-scale high-precision physical head model based on the 3D images was created using a 3D printer (3D Systems Z Printer 450). To reproduce accurate bone thickness, the thickness of the bone valves of five craniotomy patients was measured as a preliminary experiment. The appropriate threshold (500) that accurately represented bone thickness was identified by examining bone valve models created with five different thresholds. The 3D head model was used for preoperative simulation (dry run). It was evaluated following a series of procedures: (1) non-contact registration, (2) creation of a bone hole with a twist drill, (3) anchor bolt fixation, and (4) electrode implantation.
Results:
Presurgical simulation of a series of surgical procedures was performed in two SEEG cases. In particular, since the bone hole creation was confirmed from the brain side after drilling, an accurate drill length for this procedure was achieved in advance to avoid dural damage. Interference between bolts and electrodes could also be accurately pre-evaluated. All the bony holes could be created in a single drilling operation.
SEEG has been known as a relative safer surgical procedures. Especially, the frequency of intracranial hemorrhage caused by SEEG was 4.4%, which is lower than that caused by subdural electrodes (4.8%). However, since many procedures such as the creation of a bone hole with a twist drill are not common in neurosurgery, the preoperative review with the head model was useful to perform both accurate and safe neurosurgical procedures.
Conclusions:
The preoperative simulation of SEEG with a patient 3D facial head model was efficient for an proper training and preoperative review by neurosurgeons.
Funding: No