Abstract：Objective To explore the application value of three-dimensional(3D) printing model of diseases in sella area based on thin-layer enhanced scanning data in preoperative planning and intraoperative guiding of operation.Methods A prospective study method was conducted in the Neurosurgery Department of Fuzhou General Hospital from March 2015 to June 2017.Fifteen patients with diseases in sella area, 6 males and 9 females, aged from 40 to 75 years old were enrolled, including 13 patients with pituitary adenomas, 1 patient of meningioma located in sella turcica tubercle and 1 patient of aneurysm located in the upper segment of the internal carotid artery, The computed tomography angiography(CTA) and MRI thin-layer scan data were input into mimic software to creat a digital model ,then the model was created by 3D printer. Analyze the anatomical relationship between the lesion and the surrounding structure on the 3D printed model, simulate the surgical approach and surgical operation, and determine the surgical plan. Thirteen patients with pituitary adenomas were resected by microsurgery via unilateral nasal-sphenoidal approach,1 patient of meningioma located in sella turcica tubercle was resected by craniotomy, and 1 patient of large aneurysm located in the upper segment of the internal carotid artery was clipped by craniotomy. All the patients were successfully operated. The simulation results of the model were further referenced and verified in operation.Results On the 3D printing model,13 patients of pituitary adenoma can clearly show the shape of sellar eminence, sphenoidal sinus size, gasification type, sphenoidal septum and the shape of posterior wall of sphenoidal sinus, and can also observe the osseous eminence of lateral wall, under the perspective of transsphenoidal approach. According to the results of imaging and 3D model observation, appropriate sellar floor fenestration was performed. The lateral margin of the fenestration did not involve the internal carotid artery, the upper margin reached the anterior cavernous sinus, and the lower margin was exposed adequately. One patient of tuberculum sellae meningioma and 1 patient of aneurysm were closely related to the anterior clinoid process, and intraoperative findings were consistent with the 3D print model. The clinical operation of 13 patients was successfully completed. No complications such as vascular and important brain tissue damage, cerebrospinal fluid leakage and infection occurred during and after operation.Conclusions The 3D printing models can clearly show the relationship between the lesions in the sellar region and surrounding bone, blood vessels. It provides a good and intuitive stereoscopic anatomical structure for the plan of preoperative surgical procedures, and can be used to simulate surgical operations, thereby improving the safety of surgery.
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2018, Vol. 23 
