Proposed Topic (Most preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Chow SWJ(1), Poon TL(1), Lam LYM (2), QEH 3D Printing Office, Queen Elizabeth Hospital (2), Department of Diagnostic Imaging & Radiology, Queen Elizabeth Hospital (3)
Affiliation :
(1) Department of Neurosurgery, Queen Elizabeth Hospital, (2) QEH 3D Printing Office, Queen Elizabeth Hospital, (3) Department of Diagnostic Imaging & Radiology, Queen Elizabeth Hospital
Introduction :
Stereoelectroencephalography (SEEG) is a minimally invasive procedure used for pre-surgical evaluation of refractory epilepsy. It allows for multiple electrode placement into deeper brain regions and extensive network coverage of the seizure pathway in both hemispheres, allowing for a more comprehensive collection of clinical data to precisely localize the epileptogenic zone. SEEG can also be used for resective surgical planning and treatment by radiofrequency thermocoagulation. Approximately 40% of adult-onset epilepsies and a lesser proportion in pediatrics have no known cause for their seizures, making them traditionally not candidates for curative resective surgeries. About 20% of patients with complex focal epilepsy undergo SEEG as an invasive diagnostic procedure due to non-concordant test results. The surgery, which lasts 4-6 hours and is performed under general anesthesia, involves CT and MRI brain imaging, vascular imaging, functional MRI, and diffuse tensor imaging (DTI). SEEG is helpful in 80% of patients to confirm or annul surgical indications or adjust resection extent.
Objectives :
This project aims to reinforce training quality and safety of stereoelectroencephalography procedure by using 3D printing technology in fabricating a 3D printed skull model.
Methodology :
The skull model contains a drillable skull bone, CT visible blood vessels and lesion targets and a highly resembling brain jelly. The 3D printed model is scanned using a CT scanner for image acquisition, which can then be uploaded to stereotactic imaging systems for planning and navigation. Neurosurgical trainees review lesions in relation to skull bone and vascular structures, assimilate epileptogenic foci from patient images, and plan SEEG trajectories using an orthogonal or oblique approach.
Result & Outcome :
Measurements of skull bone thickness, electrode depth, and skin-to-target distances can be obtained before the procedure. The skull bone can be opened to review the puncture site and trajectory. The brain model allows radiofrequency ablation, allowing for visual observation of microbubbling and changes in brain matter resistance after the procedure. The electrode punctures a lesion, causing a tactile "pop" sensation for trainees. Our 3D printed skull model has received positive feedback, useful in knowledge and skills acquisition and enables clinicians to mimic the whole procedure of stereoelectroencephalography.
