3D Surgical Planning and 3D Printing of Skull Base Anatomy for Endoscopic Endonasal Approach to Resection of Meckel's Cave Mass

Objective: Advancements in medical and radiation oncology have reduced the need for surgical management of lesions in inaccessible areas of the skull base. However, surgical management remains necessary in many circumstances. Careful preoperative imaging and planning is critical for allowing surgeons to operate safely and confidently in areas that are anatomically difficult to conceptualize and challenging to instrument. We found two 3D reconstruction methods extremely useful for planning an endonasal approach to a mass in Meckel's cave.

Methods: A 61-year-old male with left aural fullness and facial pain was found to have a left parasellar mass extending into the cavernous sinus and Meckel's cave, and a tissue biopsy for definitive diagnosis was needed. 3D images were reconstructed with Surgical Theater, LLC's “Surgical Navigation Advanced Platform” (SNAP) and open-source software based models. The SNAP was coupled to BrainLab navigation for operative interactivity. Structural models were printed at 1:1 scale in full color.

Results: The 3D models confirmed that we could safely and adequately expose the mass and highlighted the relationship of the mass to critical neurovascular structures. We successfully performed an endoscopic transsphenoid/transpterygoid approach to Meckel's cave for biopsy. Postoperatively, the patient had no neurologic or vascular complications.

Conclusion: Effective surgical planning with 3D models can aid in appropriate patient selection by defining the limitations of surgical instrumentation and has the potential to decrease time under general anesthesia while decreasing morbidity and mortality by allowing surgeons to better understand complex spatial anatomy and operate with greater confidence.