Validation of a 3D Printed Model for Pituitary Neuroendocrine Tumor Resection, Vascular Injury Management, Cerebrospinal Leak Repair, and Skull Base Reconstruction

Background: Endoscopic pituitary surgery is a subspecialty field which benefits significantly from high fidelity surgical simulators. Giving trainees an opportunity to practice resection of a sellar tumor and management of a large vessel injury on surgical simulators will improve training.

Methods: A pituitary surgery course will run for the second iteration at the end of 2024. During the first iteration neurosurgeons and ENT surgeons of varying experience agreed to participate in assessing the validity of a 3D-printed pituitary surgery model ([Fig. 1]). This model allowed participants to perform a transsphenoidal exposure and resection of a pituitary neuroendocrine tumor, repair a CSF leak, control a carotid injury and repair a skull base defect ([Fig. 2]). The content, face and construct validity of the 3D printed model was examined. The second iteration will involve examining time taken to complete each stage of the simulator as well as volume of blood lost during the major vascular injury. This will be correlated with the participants’ pre-course experience to assess construct validity.

Fig. 1 The pituitary adenoma, vascular injury and CSF leak repair surgical simulator.

Fig. 2 The steps to be completed using the surgical simulator A-N. (A) incising through septal mucosa and beginning to raise a nasoseptal flap (B) removal of left sided septal spur (C) complete raising of nasoseptal flap and storing in the nasopharynx (D) bilateral middle turbinectomies (E) removal of the sphenoid rostrum (F) peeling the sphenoidal mucosa off the face of the sella (G) high speed drill to thin the bone over the sella (H) Kerrison-Rongeur to complete exposure of sella (I) durotomy (J) resection of the pituitary adenoma (K) injury to the diaphragma with subsequent CSF leak (L) repair of CSF leak using bathplug technique with chicken fat (M) injury to the carotid artery (N) use of two-surgeon four-hand approach to managing major vascular injury and placement of a harvested chicken muscle patch (O) successfully control the haemorrhage

Results: During the first iteration of the course the heart rate of the participants significantly increased from baseline when starting the carotid injury simulation (mean: 90 vs. 121) and significantly decreased once the injury was controlled (mean: 121 vs. 110).

The participants reported a significant improvement in anxiety in facing a major vascular injury, an increase in their confidence in management of major vascular injury, resecting a pituitary adenoma and repair of a CSF leak using a 5-point Likert scale (mean: 4.42 vs. 3.58, p = 0.05, 2.0 vs. 3.25, 2.36 vs. 4.27 and 2.45 vs. 4.0, respectively), [Fig. 3]. The data from the second iteration of the course in late 2024 will be used to expand these results.

Fig. 3 Dot plots demonstrating the change in self rated anxiety and competence for management of carotid injury, as well as management of pituitary adenoma resection and CSF leak repair from the first iteration of the course.

Conclusion: Using the data from both iterations of this course will demonstrate validity of a 3D-printed surgical simulator for endoscopic pituitary surgery that allows surgeons to practice a transsphenoidal approach and resection of a pituitary adenoma.

Publication History

Article published online:
07 February 2025