3D printing in adult and pediatric neurosurgery: the present and the future

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Introduction

The technology of three-dimensional (3D) printing has emerged since a few decades now and it has been described as a transformative technology with the potential to reform medicine. In neurosurgery, with the wide variety of pathologies and the broad use of innovative technologies, 3D printing has gradually been introduced as an adjunct tool to daily practice. Still, it has not been integrated as yet in the clinical routine or as part of standard of care in the vast majority of neurosurgical activities worldwide. Although 3D printed custom-made xenografts for cranioplasty are a fine example of its applications, presently the use of 3D printing technology is relatively not widespread and is mainly being used for educational, patient consultation, and preoperative planning purposes.

However, technological advances have streamlined the manufacturing processes and decreased purchase and production costs, while the range of materials used has expanded. Undoubtedly, the above have rendered 3D printing technology very promising and more accessible, with a great potential to play a core role in the concept of personalized medicine in the ever-evolving field of neurosurgery. In this respect, numerous potential applications of 3D printing have been proposed both in adult and pediatric neurosurgery, crystallizing the transition from the “one-size-fits-all” to the “tailor-made” concept of neurosurgical clinical practice.

As mentioned above, the introduction and expansion of 3D printing within the field of neurosurgery has prompted multiple new uses of this technology, from preoperative planning to surgical teaching and assessment. However, while earlier uses of 3D printing in neurosurgery primarily focused on the development of accurate patient-specific models, more recent studies integrate 3D printed models into neurosurgical training, in the manufacturing of implants, and in combining 3D printed features with virtual reality (VR) or augmented reality (AR) for enhanced simulated cases.

This chapter will review the current clinical applications described in the literature, the modalities of 3D printing implemented, and the advantages and limitations of its use and will further discuss potential future directions of the technology within both adult and pediatric neurosurgery. While specific 3D printing modalities utilized in neurosurgery may be briefly described, a detailed discussion of these printing methodologies and the 3D printing software available will be beyond the scope of this chapter.

Applications

In a recent systematic review, Randazzo et al. described the applications of 3D printing as falling within the following categories: surgical planning and modeling, training and simulation, and neurosurgical devices and implants. These uses of 3D printing have been examined within the full spectrum of neurosurgical subspecialties, from spine and neuro-oncology to cerebrovascular and functional. Another recent review by Langridge et al. further details the uses of 3D printing within surgical teaching and assessment, identifying neurosurgery as one of the most common specialties in which this technology has been employed for this purpose. The following sections highlight some of the applications of 3D printing within the subspecialties of adult and pediatric neurosurgery.

Adult neurosurgery