Increasing the safety of surgical treatment for complex Cranio-vertebral anomalies using customized 3D printed models

Surgery for the Cranio-vertebral (CV) junction anomalies using top loading subocciput (C0)/C1-C2 screws is difficult and requires high level of skill and expertise. This is because of complex abnormal anatomy in that region and other issues including the instrumentation. Thorough knowledge of the 3D anatomy of the Craniovertebral junction of the patient is essential for favourable outcome. The customised 3D printed model of CV junction region of the patient can be used for studying the anatomy and relationship of vertebral artery to the C1-C2 joint before the actual surgery. Thirteen patients (includes twelve males and one female) of congenital CV junction anomalies having AAD with or without BI (Basilar Invagination) were included in the study. For all thirteen patients, customised 3D models of CV junction were made based on their CT scan data. The rehearsal of surgical procedure on the model was done a day before the actual surgery. Post surgery, twelve out of thirteen patients showed significant clinical and radiological improvement. We did not had any misplaced screws or vertebral artery injury. 3D models can improve decision making and planning of the surgical procedure in the CV junction region. It unmasks abnormal bony & vascular anatomy effectively. Moreover the rehearsal of the surgical procedure enables the surgical team to be more confident & familiar with the anatomy during the actual surgery.