Cíl: Cílem této práce bylo zhodnocení našich zkušeností s metodou 3D tisku v neurochirurgii. Vedle známé tvorby kraniálních implantátů je možné mnohem širší využití této moderní, rychle se rozvíjející technologie. Metodika: Představujeme a hodnotíme soubor našich deseti pacientů, kteří byli operováni s využitím metody 3D tisku. V oblasti cévní neurochirurgie se jednalo ve čtyřech případech o model mozkového aneuryzmatu a o jeden model arteriovenózních malformací. U dvou pacientů metoda přispěla k uzavření defektu lební baze „na míru“ tvarovanou mřížkou a v neuroonkologii u dvou pacientů zlepšila naši představu o pozici nádorů lební baze. U jednoho pacienta 3D model obratle C2 umožnil volbu optimální trajektorie fixačního materiálu. Výsledky: Ve zmíněných případech bylo dosaženo požadovaného výsledku a u všech pacientů metoda 3D tisku přispěla ke správnému ošetření. Závěr: Na základě našich zkušeností si dovolujeme konstatovat, že kromě již běžně využívané 3D implantologie metoda 3D tisku představuje zajímavou a inovativní modalitu v oblastech neurochirurgického plánování, simulace a tréninku. Předpokládáme, že se bude stále více uplatňovat v mnoha oblastech neurochirurgie.

Aim: The aim of this work was to evaluate our experience with the 3D printing method in neurosurgery. In addition to the well-known utilization of cranial implants, a significant use of this modern, rapidly developing technology is possible. Methods: We present and evaluate the series of our ten patients, which we operated on using 3D printing methods. In the field of vascular neurosurgery, four cases involved a brain aneurysm model and one arteriovenous malformation model. In two patients, this method contributed to the closure of the skull base defect with a custom-shaped cranial grid and in neuro-oncology, it improved the visualization of skull base tumors in two patients. In one patient, the 3D model of the C2 vertebra allowed the choice of the optimal trajectory of the fixation material. Results: In the mentioned cases, the desired result was achieved and the 3D printing method was adapted to the correct treatment in all patients. Conclusion: Based on our experiences, we can claim that the 3D printing method, in addition to the already commonly used 3D implantology, also presents a new and interesting modality in the field of neurosurgical planning, simulation and training. We assume that it will be increasingly used in many areas of neurosurgery.

• MeSH
• Printing, Three-Dimensional * instrumentation   MeSH
• Adult MeSH
• Intracranial Aneurysm surgery   diagnostic imaging   MeSH
• Middle Aged MeSH
• Humans MeSH
• Central Nervous System Diseases surgery   diagnostic imaging   MeSH
• Neurosurgery * methods   trends   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Clinical Study MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: The presented study investigates the application of bi-arterial 3D printed models to guide transseptal puncture (TSP) in left atrial appendage closure (LAAC). AIMS: The objectives are to (1) test the feasibility of 3D printing (3DP) for TSP guidance, (2) analyse the distribution of the optimal TSP locations, and (3) define a CT-derived 2D parameter suitable for predicting the optimal TSP locations. METHODS: Preprocedural planning included multiplanar CT reconstruction, 3D segmentation, and 3DP. TSP was preprocedurally simulated in vitro at six defined sites. Based on the position of the sheath, TSP sites were classified as optimal, suboptimal, or nonoptimal. The aim was to target the TSP in the recommended position during the procedure. Procedure progress was assessed post hoc by the operator. RESULTS: Of 68 screened patients, 60 patients in five centers (mean age of 74.68 ± 7.64 years, 71.66% males) were prospectively analyzed (3DP failed in one case, and seven patients did not finally undergo the procedure). In 55 patients (91.66%), TSP was performed in the optimal location as recommended by the 3DP. The optimal locations for TSP were postero-inferior in 45.3%, mid-inferior in 45.3%, and antero-inferior in 37.7%, with a mean number of optimal segments of 1.34 ± 0.51 per patient. When the optimal TSP location was achieved, the procedure was considered difficult in only two (3.6%) patients (but in both due to complicated LAA anatomy). Comparing anterior versus posterior TSP in 2D CCT, two parameters differed significantly: (1) the angle supplementary to the LAA ostium and the interatrial septum angle (160.83° ± 9.42° vs. 146.49° ± 8.67°; p = 0.001), and (2) the angle between the LAA ostium and the mitral annulus (95.02° ± 3.73° vs. 107.38° ± 6.76°; p < 0.001), both in the sagittal plane. CONCLUSIONS: In vitro TSP simulation accurately determined the optimal TSP locations for LAAC and facilitated the procedure. More than one-third of the optimal TSP sites were anterior.

• MeSH
• Printing, Three-Dimensional MeSH
• Atrial Fibrillation * therapy   surgery   MeSH
• Humans MeSH
• Tomography, X-Ray Computed MeSH
• Punctures methods   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Atrial Appendage * diagnostic imaging   surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

The lowest possible energy of proton scanning beam in cyclotron proton therapy facilities is typically between 60 and 100 MeV. Treatment of superficial lesions requires a pre-absorber to deliver doses to shallower volumes. In most of the cases a range shifter (RS) is used, but as an alternative solution, a patient-specific 3D printed proton beam compensator (BC) can be applied. A BC enables further reduction of the air gap and consequently reduction of beam scattering. Such pre-absorbers are additional sources of secondary radiation. The aim of this work was the comparison of RS and BC with respect to out-of-field doses for a simulated treatment of superficial paediatric brain tumours. EURADOS WG9 performed comparative measurements of scattered radiation in the Proteus C-235 IBA facility (Cyclotron Centre Bronowice at the Institute of Nuclear Physics, CCB IFJ PAN, Kraków, Poland) using two anthropomorphic phantoms-5 and 10 yr old-for a superficial target in the brain. Both active detectors located inside the therapy room, and passive detectors placed inside the phantoms were used. Measurements were supplemented by Monte Carlo simulation of the radiation transport. For the applied 3D printed pre-absorbers, out-of-field doses from both secondary photons and neutrons were lower than for RS. Measurements with active environmental dosimeters at five positions inside the therapy room indicated that the RS/BC ratio of the out-of-field dose was also higher than one, with a maximum of 1.7. Photon dose inside phantoms leads to higher out-of-field doses for RS than BC to almost all organs with the highest RS/BC ratio 12.5 and 13.2 for breasts for 5 and 10 yr old phantoms, respectively. For organs closest to the isocentre such as the thyroid, neutron doses were lower for BC than RS due to neutrons moderation in the target volume, but for more distant organs like bladder-conversely-lower doses for RS than BC were observed. The use of 3D printed BC as the pre-absorber placed in the near vicinity of patient in the treatment of superficial tumours does not result in the increase of secondary radiation compared to the treatment with RS, placed far from the patient.

• MeSH
• Printing, Three-Dimensional * MeSH
• Radiotherapy Dosage MeSH
• Radiation Dosage * MeSH
• Child MeSH
• Phantoms, Imaging MeSH
• Humans MeSH
• Monte Carlo Method MeSH
• Brain Neoplasms radiotherapy   MeSH
• Neutrons MeSH
• Computer Simulation MeSH
• Proton Therapy instrumentation   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH

Due to the possibility of designing various spatial structures, three-dimensional printing can be implemented in the production of customized medicines. Nevertheless, the use of these methods for the production of dosage forms requires further optimization, understanding, and development of printouts' quality verification mechanisms. Therefore, the goal of our work was the preparation and advanced characterization of 3D printed orodispersible tablets (ODTs) containing fluconazole, printed by the fused deposition modeling (FDM) method. We prepared and analyzed 7 printable filaments containing from 10% to 70% fluconazole, used as model API. Obtaining a FDM-printable filament with such a high API content makes our work unique. In addition, we confirmed the 12-month stability of the formulation, which, to our knowledge, is the first study of this type. Next, we printed 10 series of porous tablets containing 50 mg of API from both fresh and stored filaments containing 20 %, 40 %, or 70 % fluconazole. We confirmed the high quality and precision of the printouts using scanning electron microscopy. The detailed analysis of the tablets' disintegration process included the Pharmacopeial test, but also the surface dissolution imaging analysis (SDI) and the test simulating oral conditions performed in own-constructed apparatus. For each composition, we obtained tablets disintegrating in less than 3 min, i.e., meeting the criteria for ODTs required by the European Pharmacopeia. The filaments' storage at ambient conditions did not affect the quality of the tablets. All printed tablets released over 95% of the fluconazole within 30 min. Moreover, the printouts were stable for two weeks.

• MeSH
• Printing, Three-Dimensional * MeSH
• Technology, Pharmaceutical methods   MeSH
• Fluconazole * MeSH
• Porosity MeSH
• Tablets chemistry   MeSH
• Drug Liberation MeSH
• Publication type
• Journal Article MeSH

Direct composite restorations are accepted as a treatment option for microdontia, which is a relatively prevalent condition that poses esthetic concerns. While free-hand composite placement is technique-sensitive and time-consuming, the resin composite injection technique is more straightforward and predictable. A fully digital workflow has been recently introduced, but the 3D-printed resin index is rigid and challenged by undercuts, as opposed to the silicone index. This case report presents a flexible 3D-printed resin index, which can accurately transfer the digitally simulated functional and esthetic form to the final restoration. In addition, a rigid stabilization holder was designed to stabilize the flexible index.

• MeSH
• Printing, Three-Dimensional MeSH
• Esthetics, Dental * MeSH
• Humans MeSH
• Workflow MeSH
• Silicones MeSH
• Composite Resins * therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

The Albania SimSmoke simulation model is used to examine the effects of tobacco control policies. The model is used to consider the projected trends in smoking prevalence and associated smoking-attributable deaths in the absence of new policies, and then to examine the effect of new policies that are consistent with the Framework Convention for Tobacco Control (FCTC) on these outcomes. The model shows that significant inroads to reducing smoking prevalence and premature mortality can be achieved through tax increases. Acomprehensive strategy to further reduce smoking rates should include a media campaign complete with programs to publicize and enforce clean air laws, a comprehensive cessation treatment program, strong health warnings, advertising bans, and youth access laws. Besides presenting the benefits of a comprehensive tobacco control strategy, the model helps to identify important information needed for both modeling and policymaking. The effectiveness of future tobacco control policy will require proper surveillance and evaluation schemes for Albania.

• MeSH
• Taxes legislation & jurisprudence   MeSH
• Adult MeSH
• Program Evaluation MeSH
• Risk Assessment MeSH
• Mass Media MeSH
• Advertising legislation & jurisprudence   MeSH
• Smoking epidemiology   adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Mortality trends   MeSH
• Computer Simulation MeSH
• Fees and Charges legislation & jurisprudence   MeSH
• Birth Rate trends   MeSH
• Tobacco Use Disorder epidemiology   complications   prevention & control   MeSH
• Prevalence MeSH
• Smoking Prevention MeSH
• Social Control Policies MeSH
• Aged MeSH
• Tobacco Industry legislation & jurisprudence   MeSH
• Air Pollution legislation & jurisprudence   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Geographicals
• Albania MeSH

PURPOSE: Endoscopically assisted sagittal strip craniotomy with subsequent cranial orthosis is a frequently used surgical approach for non-syndromic sagittal synostosis. Originally, this technique involved a wide sagittal strip craniectomy with bilateral wedge osteotomies. More recent studies suggest omitting wedge osteotomies, achieving similar outcomes. The controversy surrounding wedge osteotomies and our efforts to refine our technique led us to create models and evaluate the mechanical impact of wedge osteotomies. METHODS: We conducted a 3D-print study involving preoperative CT scans of non-syndromic scaphocephaly patients undergoing minimally invasive-assisted remodelation (MEAR) surgery. The sagittal strip collected during surgery underwent thickness measurement, along with a 3-point bending test. These results were used to determine printing parameters for accurately replicating the skull model. Model testing simulated gravitational forces during the postoperative course and assessed lateral expansion under various wedge osteotomy conditions. RESULTS: The median sagittal strip thickness was 2.00 mm (range 1.35-3.46 mm) and significantly positively correlated (p = 0.037) with the median force (21.05 N) of the 3-point bending test. Model testing involving 40 models demonstrated that biparietal wedge osteotomies significantly reduced the force required for lateral bone shift, with a trend up to 5-cm-long cuts (p = 0.007). Additional cuts beyond this length or adding the occipital cut did not provide further significant advantage (p = 0.1643; p = 9.6381). CONCLUSION: Biparietal wedge osteotomies reduce the force needed for lateral expansion, provide circumstances for accelerated head shape correction, and potentially reduce the duration of cranial orthosis therapy.

• MeSH
• Printing, Three-Dimensional * MeSH
• Models, Anatomic MeSH
• Endoscopy methods   MeSH
• Infant MeSH
• Craniosynostoses * surgery   MeSH
• Craniotomy methods   MeSH
• Humans MeSH
• Osteotomy * methods   MeSH
• Tomography, X-Ray Computed MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: The recent development of three-dimensional (3D) technologies introduces a novel set of opportunities to the medical field in general, and specifically to surgery. The preoperative phase has proven to be a critical factor in surgical success. Utilization of 3D technologies has the potential to improve preoperative planning and overall surgical outcomes. In this narrative review article, the authors describe existing clinical data pertaining to the current use of 3D printing, virtual reality, and augmented reality in the preoperative phase of bone surgery. METHODS: The methodology included keyword-based literature search in PubMed and Google Scholar for original articles published between 2014 and 2022. After excluding studies performed in nonbone surgery disciplines, data from 61 studies of five different surgical disciplines were processed to be included in this narrative review. RESULTS: Among the mentioned technologies, 3D printing is currently the most advanced in terms of clinical use, predominantly creating anatomical models and patient-specific instruments that provide high-quality operative preparation. Virtual reality allows to set a surgical plan and to further simulate the procedure via a 2D screen or head mounted display. Augmented reality is found to be useful for surgical simulation upon 3D printed anatomical models or virtual phantoms. CONCLUSIONS: Overall, 3D technologies are gradually becoming an integral part of a surgeon's preoperative toolbox, allowing for increased surgical accuracy and reduction of operation time, mainly in complex and unique surgical cases. This may eventually lead to improved surgical outcomes, thereby optimizing the personalized surgical approach.

• MeSH
• Printing, Three-Dimensional MeSH
• Models, Anatomic MeSH
• Humans MeSH
• Virtual Reality * MeSH
• Plastic Surgery Procedures * MeSH
• Imaging, Three-Dimensional methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

While assessing skeletal injuries in human skeletal remains, forensic anthropologists are frequently presented with fractured, fragmented, or otherwise modified skeletal remains. The examination of evidence and the mechanisms of skeletal injuries often require that separate osseous elements be permanently or temporarily reassembled or reconstructed. If not dealt with properly, such reconstructions may impede accurate interpretation of the evidence. Nowadays, routine forensic examinations increasingly incorporate digital imaging technologies. As a result, a variety of PC-assisted imaging techniques, collectively referred to as the virtual approach, have been made available to treat fragmentary skeletal remains. The present study employs a 3D virtual approach to assess mechanisms of skeletal injuries, and provides an expert opinion of causative tools in three forensic cases involving human skeletal remains where integrity was compromised by multiple peri- or postmortem alterations resulting in fragmentation and/or incompleteness. Three fragmentary skulls and an incomplete set of foot bones with evidence of perimortem fractures (gunshot wounds) and sharp force trauma (saw marks) were digitized using a desktop laser scanner. The digitized skeletal elements were reassembled in the virtual workspace using functionalities incorporated in AMIRA® version 5.0 software, and simultaneously in real physical space by traditional reconstructive approaches. For this study, the original skeletal fragments were substituted by replicas built by 3D printing. Inter-method differences were quantified by mesh-based comparison after the physically reassembled elements had been re-digitized. Observed differences were further reinforced by visualizing local variations using colormaps and other advanced 3D visualization techniques. In addition, intra-operator and inter-operator error was computed. The results demonstrate that the importance of incorporating the virtual approach into the assessment of skeletal injuries increases with the complexity and state of preservation of a forensic case. While in relatively simple cases the virtual approach is a welcome extension to a traditional approach, which merely facilitates the analysis, in more complex and extensively fragmentary cases such as multiple gunshot wounds or dismemberment, the virtual approach can be a crucial step in applying the principles of gunshot wounds or sharp force traumatic mechanisms. The unrestricted manipulation with digital elements enabling limitless repairs and adjustments to a "best-case scenario" also produced smaller inter-operator variation in comparison to the traditional approach.

• MeSH
• Printing, Three-Dimensional MeSH
• Adult MeSH
• Fractures, Bone pathology   MeSH
• Skull Fractures pathology   MeSH
• Foot Bones injuries   pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Wounds, Penetrating pathology   MeSH
• Computer Simulation * MeSH
• Image Processing, Computer-Assisted * MeSH
• Forensic Anthropology methods   MeSH
• Wounds, Gunshot pathology   MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

PURPOSE OF THE STUDY We hypothesized that preoperative planning with 3D modeling of complex foot deformities would be useful for the education of orthopedics and traumatology residents. MATERIAL AND METHODS This study is prospectively designed study with a control group. Twenty eight residents (study group) who assisted the surgeons during the interventions and ten senior surgeons (control group) were included in the study. All participants assessed virtual 3D-CT images and videos of the cases before the surgery. Ten adult cases of foot bone deformities were evaluated. 3D-CT reconstruction was performed and a 3D model of each deformity was created using the hospital's picture archiving and communication system. The completed 3D models were sterilized in hydrogen peroxide and put on the surgical table in a sterile manner. After surgery, the residents (group I) and surgeons (group II) were questioned regarding their satisfaction with 3D modeling. Responses were structured by a five-point Likert scale (1, strongly disagree; 2, disagree; 3, neither agree nor disagree; 4, agree; and 5, strongly agree). RESULTS The surgeons (group II, n = 10) were satisfied with the sterilized 3D models, which they could touch and re-examine on the operating table. The residents (group I, n = 28) were significantly more satisfied than the senior surgeons (p=0.01). The 3D modeling met both the surgeons' and residents' expectations. DISCUSSION The survey results for the surgeons (group II) were satisfied with the sterilized 3D models, which they could touch and reexamine on the operating table (question 3). They gave the best scores (mean, 4.8/5) for clarity of the 3D model. On the other hand, they gave the lowest scores (mean 3.1/5) to 3D models due to its contribution in understanding deformity over virtual 3D-CT evaluations (question 2 and 5). The residents (group I) differed from those for the senior surgeons. Residents gave the highest scores for understanding of the deformity (question 2 and 5) and clarity (question 1). These outcomes may be interpreted to indicate i) that 3D modeling may be used for education, and ii) that younger surgeons are more interested in novel technological developments. Therefore, the outcomes did differ significantly between the senior surgeons and residents (Table 1). These outcomes may be explicated as; 3D modeling of the foot deformities may not be mandatory for the experienced surgeons for understanding the deformity. On the other hand 3D modeling would be useful tools for younger surgeons and for their education. CONCLUSIONS 3D modeling of foot deformities is more informative than virtual 3D videos. However, with consideration of costs and long processing times, 3D printing may be used optimally for rare deformities. When considering the role of touch sense in surgical learning, 3D modeling gives more detailed and more satisfactory planning than virtual 3D videos. 3D modeling is more useful for young surgeons, and it will be used mainly for education in the future. Key words: 3D printing, deformity, foot and ankle, simulation.

• MeSH
• Printing, Three-Dimensional MeSH
• Surgeons * MeSH
• Foot Deformities * MeSH
• Adult MeSH
• Humans MeSH
• Orthopedics * MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH