Application of 3D Printing Technology in Microvascular Decompression for Trigeminal Neuralgia via Retrosigmoid Craniotomy

Summary

This protocol evaluates the application of 3D printing technology in cranial microvascular decompression for trigeminal neuralgia via retrosigmoid craniotomy, with a focus on individualized image data import, image processing, 3D model fabrication, intraoperative surgical guidance, and postoperative outcomes.

Abstract

Retrosigmoid craniotomy is the preferred surgical approach for treating cerebellopontine angle (CPA) lesions, particularly for microvascular decompression in primary trigeminal neuralgia. However, inaccurate localization of the transverse-sigmoid sinus junction (TSSJ) often leads to postoperative complications. To address this issue, the E-3D digital medical modeling and design system was employed for preoperative visualization and localization of the TSSJ, enabling precise surgical planning. The E-3D software identified the optimal position for the strategic burr hole, visualized its spatial relationship with the sigmoid and transverse sinuses, and facilitated the creation of a 3D-printed surgical guide plate to assist intraoperative navigation. This protocol minimizes injury to the sigmoid and transverse sinuses, reduces the risk of excessive skull defects, and helps prevent postoperative complications such as cerebrospinal fluid (CSF) leakage and infection. Overall, the integration of 3D printing technology and surgical guide plates enhances the safety and precision of retrosigmoid craniotomy.

Introduction

The retrosigmoid craniotomy (RCS) is one of the most widely used surgical approaches for accessing the CPA. This technique offers several advantages, including ease of operation, clear exposure of the cerebellopontine angle structures, and the ability to open the internal auditory canal as needed while preserving the facial nerve, auditory nerve, and surrounding vasculature. As a result, RCS has become the preferred surgical approach for treating pathologies in the CPA region¹. However, during microvascular decompression via retrosigmoid craniotomy for trigeminal neuralgia, it is essential to fully expose the junction of the sigmoid an....

Protocol

The General Hospital of Ningxia Medical University approved the use of 3D printing to guide surgical procedures for the treatment of a 65-year-old patient with trigeminal neuralgia (KYLL-2025-1006). Written informed consent was obtained from the patient. The 3D printing supplies were commercially obtained. The reagents and equipment used in the study are listed in the Table of Materials.

1. Collection and recording of the patient's medical history

1. Communicate with the patient to assess the location of trigeminal neuralgia, frequency of attacks, pain characteristics, associated symptoms, and ....

Results

All patients were diagnosed with primary trigeminal neuralgia, and multiple sclerosis was excluded. Clinical examination revealed the involvement of the maxillary branch of the ipsilateral trigeminal nerve and, to a lesser extent, the mandibular branch. The pain was characterized by an electric shock-like quality and could be triggered by activities such as toothbrushing or tapping on the trigger points. The duration of pain episodes varied, and no abnormalities in corneal reflexes or facial motor function were observed........

Discussion

Retrosigmoid craniotomy is the preferred surgical approach for microvascular decompression (MVD) in trigeminal neuralgia, requiring adequate exposure of the sigmoid sinus and transverse sinus junction¹³. After CSF drainage, the cerebellum is retracted using the angle between the cerebellar vermis and the petrous bone to expose the CPA region. Lesions in the CPA region include, but are not limited to, trigeminal neuralgia, acoustic neuromas, cholesteatomas, trigeminal nerve sheath tumors, and facia.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
3D printing supplies	Zhongshan Dajian Technology Co.	UTR8360X
Cranial stabilization & Brain retraction	Mayfield Ltd.	A2000
CT	Siemens Medical Systems Ltd.	SOMATOM Force
E-3Ddigital medical modeling and design system	Hunan Liuwei Jinghang Digital Technology Co., Ltd.	(x64 V19.12 version)
Gauze	Yixin Medical Equipment Co.
Iodophor	Shandong Lilkang Medical Technology Co.
Medtronic IPCTM	Medtronic Medical Devices Ltd.
Methylene Blue Injection	Jumpcan PhaJumpcan Pharmaceutical Group Co., Ltd
MRI	Siemens Medical Systems Ltd.	MAGNETOM Vida
Surgical blades	Shanghai Pudong Jinhuan Medical Supplies Co.
Syringe	Hunan Oasis Huikang Development Co.
Tampon	Henan Zhongjian Medical Equipment Co.
UnionTech 3D printer	Shanghai Luen Thai Science & Technology Co.	Lite 600