Use of three-dimensional-printed models for preoperative planning in endoscopic endonasal surgery for tuberculum sellae meningioma: A case report and literature review.

BACKGROUND

Tuberculum sellae meningiomas (TSMs) are surgically demanding because of their proximity to the optic apparatus, anterior communicating artery complex, and supraclinoid carotid arteries. The expanded endoscopic endonasal approach (EEA) is a viable alternative to transcranial surgery for selected midline lesions, but safe navigation of these neurovascular relationships requires detailed preoperative planning. Patient-specific three-dimensional (3D) printing is an established tool for anatomical simulation and rehearsal before skull base surgery (SBS).

CASE DESCRIPTION: A 52-year-old female presented with 5 months of progressive headache, bitemporal hemianopsia, hyperprolactinemia, and central hypothyroidism caused by a 3.3 cm TSM with suprasellar extension. Digital imaging and communications in medicine data from contrast-enhanced magnetic resonance imaging (MRI) and computed tomography were used to build virtual and physical 1:1 scale reconstructions: Stereolithography resin for the osseous structures, flexible filament for the vasculature and tumor. The model supported trajectory planning and surgical simulation and confirmed no limitations to the EEA. A four-hand, neuronavigation-assisted transtuberculum-transplanum EEA achieved gross total resection with preservation of the optic apparatus and all vascular perforators. The patient had no cerebrospinal fluid leak or neurological deficits. Six-month follow-up MRI showed no residual disease.

CONCLUSION

Patient-specific 3D printing may represent a useful adjunct for preoperative planning and surgical simulation in selected TSM; however, further prospective studies are needed to define its cost-effectiveness and clinical impact, and its role in the acquisition and validation of the surgical learning curve in advanced SBS.