Use of three-dimensional-printed models for preoperative planning in endoscopic endonasal surgery for tuberculum sellae meningioma: A case report and literature review.

BACKGROUND: Tuberculum sellae meningiomas (TSMs) are surgically demanding because of their proximity to the optic apparatus, anterior communicating artery complex, and supraclinoid carotid arteries. The expanded endoscopic endonasal approach (EEA) is a viable alternative to transcranial surgery for selected midline lesions, but safe navigation of these neurovascular relationships requires detailed preoperative planning. Patient-specific three-dimensional (3D) printing is an established tool for anatomical simulation and rehearsal before skull base surgery (SBS). CASE DESCRIPTION: A 52-year-old female presented with 5 months of progressive headache, bitemporal hemianopsia, hyperprolactinemia, and central hypothyroidism caused by a 3.3 cm TSM with suprasellar extension. Digital imaging and communications in medicine data from contrast-enhanced magnetic resonance imaging (MRI) and computed tomography were used to build virtual and physical 1:1 scale reconstructions: Stereolithography resin for the osseous structures, flexible filament for the vasculature and tumor. The model supported trajectory planning and surgical simulation and confirmed no limitations to the EEA. A four-hand, neuronavigation-assisted transtuberculum-transplanum EEA achieved gross total resection with preservation of the optic apparatus and all vascular perforators. The patient had no cerebrospinal fluid leak or neurological deficits. Six-month follow-up MRI showed no residual disease. CONCLUSION: Patient-specific 3D printing may represent a useful adjunct for preoperative planning and surgical simulation in selected TSM; however, further prospective studies are needed to define its cost-effectiveness and clinical impact, and its role in the acquisition and validation of the surgical learning curve in advanced SBS.