BioModelling - Overview

Anatomical BioModelling is a technology whereby patient's medical scan data may be used to manufacture an exact plastic replica (biomodel) of a selected anatomical structure. Such an anatomical BioModel can then be used as a life-like 3D facsimile by the surgeon to assess abnormalities, plan surgery and communicate to the patient and colleagues. As BioModels can be sterilised they can be used for immediate intra-operative reference and contouring of bone grafts. Custom prostheses can also be manufactured using the biomodel, in advance of surgery.

There are five main indications for anatomical BioModelling. Firstly, a BioModel can provide improved diagnostic and morphological insight into a particular condition. Secondly, a BioModel can be used to simulate surgery allowing optimisation of the surgical plan. Thirdly, a BioModel can be used to prepare a customised prosthesis. Fourthly, a template or frame may be used to stereotactically transfer a surgical plan from BioModel to patient, and finally, BioModelling can be used as an intuitive communication tool between colleagues and patients.

BioModels in Craniofacial Surgery

Craniofacial conditions treated include tumours, congenital and traumatic deformities. The natural history of these conditions is that of malignant decline or chronic pain and discomfort depending on the underlying pathology. Often craniofacial pathology affects the ability of the patient to eat normally, talk, and participate in interpersonal relations due to gross cosmetic deformity. Although craniofacial conditions are not uncommon, BioModelling is reserved only for the most complex cases. It is in these cases where BioModelling makes a tremendous difference in the lives of the patients, by allowing the surgeon to more accurately understand the patient's condition, plan and even rehearse the surgical correction.

Customised Implants via BioModelling

An exact BioModel of the patient's bone structure allows a customised prosthesis (implant) to be manufactured to restore deformity due to tumour, trauma or previous surgery. The pre-operative manufacture of such implants significantly reduces operating time, and complications whilst improving the cosmetic result. Without a prefabricated implant the surgeon has to shape an implant intra-operatively, increasing the operating time and risks and often leading to a sub-optimal result. Again, customised prostheses are reserved for the more complex and severe cases where they make dramatic improvements to the patient's outcomes. An "off the shelf" prosthesis can also be customised by the surgeon before and/or during the surgery using a BioModel.

BioModels in Spinal Surgery

Anatomical BioModelling may be used for severe spinal pathology, skull base tumours, intracranial tumours, and complex cerebrovascular abnormalities. Complex spinal conditions where BioModelling has been found to be useful include tumours, degenerative spondylosis and traumatic injuries. BioModelling has been found to be particularly useful in the cervical spine and craniocervical junctions where surgery carries significant risks. The added insight of an anatomical BioModel has been found to improve the surgeon's confidence and optimise the surgical plan. Although spinal conditions are relatively common in the community, BioModelling is used only in the most complex and difficult conditions.

BioModels in Skull Base and Aneurysm Surgery

BioModels may be used to assist the surgeon in complex skull base surgery to better display the anatomical relationships and pathology. Surgery on intracranial tumours carries a major risk of morbidity and mortality. Complications in this type of surgery can lead to costly and extended hospital stays not to mention the burden of rehabilitation and long term residential care if permanent disability results. BioModelling has been used to assist neurosurgeons biopsy or excise other intracranial tumours. Mr. D'Urso has developed a technique that allows biopsy operations to be performed under local anaesthesia in a fraction of the time using a BioModel. BioModelling has been used to model cerebral aneurysms and arterio-venous malformations prior to surgery. The precise understanding of the relationships of cerebral blood vessels is best represented by a 3D BioModel. As major intracranial cerebrovascular surgery carries a significant risk advantages in the pre-operative and intra-operative use of BioModels may save considerable life years and resources in the care of stroke victims.

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