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      Creating Physical 3D Stereolithograph Models of Brain and Skull

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          Abstract

          The human brain and skull are three dimensional (3D) anatomical structures with complex surfaces. However, medical images are often two dimensional (2D) and provide incomplete visualization of structural morphology. To overcome this loss in dimension, we developed and validated a freely available, semi-automated pathway to build 3D virtual reality (VR) and hand-held, stereolithograph models. To evaluate whether surface visualization in 3D was more informative than in 2D, undergraduate students (n = 50) used the Gillespie scale to rate 3D VR and physical models of both a living patient-volunteer's brain and the skull of Phineas Gage, a historically famous railroad worker whose misfortune with a projectile tamping iron provided the first evidence of a structure-function relationship in brain. Using our processing pathway, we successfully fabricated human brain and skull replicas and validated that the stereolithograph model preserved the scale of the VR model. Based on the Gillespie ratings, students indicated that the biological utility and quality of visual information at the surface of VR and stereolithograph models were greater than the 2D images from which they were derived. The method we developed is useful to create VR and stereolithograph 3D models from medical images and can be used to model hard or soft tissue in living or preserved specimens. Compared to 2D images, VR and stereolithograph models provide an extra dimension that enhances both the quality of visual information and utility of surface visualization in neuroscience and medicine.

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          Most cited references16

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          The return of Phineas Gage: clues about the brain from the skull of a famous patient.

          When the landmark patient Phineas Gage died in 1861, no autopsy was performed, but his skull was later recovered. The brain lesion that caused the profound personality changes for which his case became famous has been presumed to have involved the left frontal region, but questions have been raised about the involvement of other regions and about the exact placement of the lesion within the vast frontal territory. Measurements from Gage's skull and modern neuroimaging techniques were used to reconstitute the accident and determine the probable location of the lesion. The damage involved both left and right prefrontal cortices in a pattern that, as confirmed by Gage's modern counterparts, causes a defect in rational decision making and the processing of emotion.
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            The application of rapid prototyping techniques in cranial reconstruction and preoperative planning in neurosurgery.

            The value of rapid prototype models of the skull in our craniofacial and neurosurgical practice was analyzed. Individual skull models of 52 patients were produced by means of rapid prototyping techniques and used in various procedures. Patients were divided into three groups as follows: group I (26 patients) requiring corrective cranioplasty 1) after resection of osseous tumors (15 patients) and 2) with congenital and posttraumatic craniofacial deformities (11 patients), group II (10 patients) requiring reconstructive cranioplasty, and group III (16 patients) requiring planning of difficult skull base approaches. The utility of the stereolithographic models was assessed using the Gillespie scoring system. The esthetic and clinical outcomes were assessed by means of the esthetic outcome score and the Glasgow Outcome Score, respectively. Simulation of osteotomies for advancement plasty and craniofacial reassembly in the model before surgery in group I reduced operating time and intraoperative errors. In group II, the usefulness of the models depended directly on the size and configuration of the cranial defect. The planning of approaches to uncommon and complex skull base tumors (group III) was significantly influenced by the stereolithographic models. The esthetic outcome was pleasing. The indications for the manufacture of individual three-dimensional models could be cases of craniofacial dysmorphism that require meticulous preoperative planning and skull base surgery with difficult anatomical and reconstructive problems. The stereolithographic models provide 1) better understanding of the anatomy, 2) presurgical simulation, 3) intraoperative accuracy in localization of lesions, 4) accurate fabrication of implants, and 5) improved education of trainees.
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              Cerebrovascular stereolithographic biomodeling for aneurysm surgery. Technical note.

              Stereolithographic (SL) biomodeling is a new technology that allows three-dimensional (3D) imaging data to be used in the manufacture of accurate solid plastic replicas of anatomical structures. The authors describe their experience with a patient series in which this relatively new visualization method was used in surgery for cerebral aneurysms. Using the rapid prototyping technology of stereolithography, 13 solid anatomical biomodels of cerebral aneurysms with parent and surrounding vessels were manufactured based on 3D computerized tomography scans (three cases) or 3D rotational angiography (10 cases). The biomodels were used for diagnosis, operative planning, surgical simulation, instruction for less experienced neurosurgeons, and patient education. The correspondence between the biomodel and the intraoperative findings was verified in every case by comparison with the intraoperative video. The utility of the biomodels was judged by three experienced and two less experienced neurosurgeons specializing in microsurgery. A prospective comparison of SL biomodels with intraoperative findings proved that the biomodels replicated the anatomical structures precisely. Even the first models, which were rather rough, corresponded to the intraoperative findings. Advances in imaging resolution and postprocessing methods helped overcome the initial limitations of the image threshold. The major advantage of this technology is that the surgeon can closely study complex cerebrovascular anatomy from any perspective by using a haptic, "real reality" biomodel, which can be held, allowing simulation of intraoperative situations and anticipation of surgical challenges. One drawback of SL biomodeling is the time it takes for the model to be manufactured and delivered. Another is that the synthetic resin of the biomodel is too rigid to use in dissecting exercises. Further development and refinement of the method is necessary before the model can demonstrate a mural thrombus or calcification or the relationship of the aneurysm to nonvascular structures. This series of 3D SL biomodels demonstrates the feasibility and clinical utility of this new visualization medium for cerebrovascular surgery. This medium, which elicits the intuitive imagination of the surgeon, can be effectively added to conventional imaging techniques. Overcoming the present limitations posed by material properties, visualization of intramural particularities, and representation of the relationship of the lesion to parenchymal and skeletal structures are the focus in an ongoing trial.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                PLoS ONE
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2007
                31 October 2007
                : 2
                : 10
                : e1119
                Affiliations
                [1 ]Waisman Laboratory for Brain Imaging and Behavior, Waisman Center, Madison, Wisconsin, United States of America
                [2 ]Medical Scientist Training Program, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
                [3 ]Neuroscience Training Program, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
                [4 ]Howard Hughes Medical Institute (HHMI) Teaching Fellows Program, Wisconsin Program for Scientific Teaching, Department of Bacteriology, University of Wisconsin, Madison, Wisconsin, United States of America
                [5 ]Paul P. Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, Wisconsin, United States of America
                [6 ]Biology New Media Center, University of Wisconsin Biotechnology Center, Madison, Wisconsin, United States of America
                [7 ]Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, United States of America
                [8 ]Department of Biochemistry, College of Agricultural and Life Science, University of Wisconsin, Madison, Wisconsin, United States of America
                [9 ]Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, United States of America
                Center for Genomic Regulation, Spain
                Author notes
                * To whom correspondence should be addressed. E-mail: djkelley@ 123456wisc.edu

                Conceived and designed the experiments: RD DK DN LR RD AA. Performed the experiments: DK MF MM AW. Analyzed the data: DK. Contributed reagents/materials/analysis tools: RD MF MM DN AW. Wrote the paper: DK MF MM RD AW.

                Article
                07-PONE-RA-02140R1
                10.1371/journal.pone.0001119
                2040197
                17971879
                e419cf51-898b-4e9e-a2f3-f87c0a681a7a
                Kelley et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                : 1 September 2007
                : 15 October 2007
                Page count
                Pages: 5
                Categories
                Research Article
                Neuroscience
                Biotechnology/Bioengineering
                Neurological Disorders/Neuroimaging
                Non-Clinical Medicine/Medical Education
                Radiology and Medical Imaging/Magnetic Resonance Imaging

                Uncategorized
                Uncategorized

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