Simulation of Pediatric Anterior Skull Base Anatomy Using a 3D Printed Model

Background: The pediatric skull base may present anatomical challenges to the skull base surgeon including limited sphenoid pneumatization and a narrow nasal corridor. The rare nature of pediatric skull base pathology makes it difficult to gain experience with these anatomical challenges.

Objective: The objective of this study was to create a 3D printed model of the pediatric skull base and assess its potential as a training tool.

Methods: Twenty one participants at various stages of training and practice were included in our study. They were asked to complete a predissection questionnaire assessing anticipated challenges followed by endoscopic endonasal skeletonization of the carotid arteries and sella face using the 3D printed model ([Figs. 1], [2]). Each participant was given a new, identical 3D printed model for individual drilling. After completion, participants completed a postdissection questionnaire assessing challenges faced.

Results: The majority of participants had completed a skull base surgery fellowship (71.4%), were <5 years into practice (61.9%), and had <10 cases of pediatric skull base experience (80.1%) (Table 1). Frequent challenges anticipated by the participants included limitation of maneuverability of instruments (76.2%), narrow nasal corridor (66.7%), and nonpneumatized bone (61.9%). On a scale of 0 to 10, 10 being very difficult, the average participant expected level of difficulty with visualization was 7.1 ± 1.73 (range, 5–10) and expected level of difficulty with instrumentation was 7.5 ± 1.94 (range, 5–10). On postdissection assessment, there was a nonstatistically significant increase to 7.3 ± 2.1 (range, 3–10) with experienced level of difficulty with visualization and 8.0 ± 2.06 (range, 3–10) with experienced level of difficulty with instrumentation, respectively. Participants endorsed on a scale of 0 to 10, 10 being very realistic, an overall model realism of 7.0 ± 1.86 (range, 3–10) and haptic realism of 7.1 ± 1.96 (range, 3–10).

Conclusion: A 3D printed model of the pediatric skull base may provide a realistic model to help participants gain experience with anatomical limitations characteristic of the pediatric anterior skull base.

Fig. 1 Posterior view of 3D printed pediatric skull base model. Red, carotid arteries; yellow, optic nerves; pink, pituitary gland; gray, anterior skull base.

Fig. 2 Endonasal view after drilling. Red stars, carotid arteries; long arrows, optic nerves; short arrows, pituitary gland.