• Davide Mattavelli, Antonio Fiorentino, Francesco Tengattini, Alessandro Colpani, Silvia Agnelli, Barbara Buffoli, Marco Ravanelli, Marco Ferrari, Alberto Schreiber, Vittorio Rampinelli, Stefano Taboni, Vincenzo Verzeletti, Alberto Deganello, Luigi Fabrizio Rodella, Roberto Maroldi, Elisabetta Ceretti, Luciana Sartore, Cesare Piazza, Marco M Fontanella, Piero Nicolai, and Francesco Doglietto.
• Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
• World Neurosurg. 2021 Nov 1; 155: e439-e452.

BackgroundEndoscopic transnasal transclival intradural surgery is limited by a high postoperative cerebrospinal fluid leak rate. The aim of this study was to investigate the role of three-dimensional printing to create a personalized, rigid scaffold for clival reconstruction.MethodsTwo different types of clivectomy were performed in 5 specimens with the aid of neuronavigation, and 11 clival reconstructions were simulated. They were repaired with polylactide, three-dimensional-printed scaffolds that were manually designed in a computer-aided environment based either on the real or on the predicted defect. Scaffolds were printed with a fused filament fabrication technique and different offsets. They were positioned and fixed either following the gasket seal technique or with screws. Postdissection radiological evaluation of scaffold position was performed in all cases. In 3 specimens, the cerebrospinal fluid leak pressure point was measured immediately after reconstruction.ResultsThe production process took approximately 30 hours. The designed scaffolds were satisfactory when no offset was added. Wings were added during the design to allow for screw positioning, but broke in 30% of cases. Radiological assessment documented maximal accuracy of scaffold positioning when the scaffold was created on the real defect; accuracy was satisfactory when the predicted clivectomy was performed under neuronavigation guidance. The cerebrospinal fluid leak pressure point was significantly higher when the scaffold was fixed with screws compared with the gasket technique.ConclusionsIn this preclinical setting, additive manufacturing allows the creation of customized scaffolds that are effective in reconstructing even large and geometrically complex clival defects.Copyright © 2021 Elsevier Inc. All rights reserved.

42 keywords...

hide…