3D Printing of Diffuse Low-Grade Gliomas Involving Eloquent Cortical Areas and Subcortical Functional Pathways: Technical Note

[Background] Surgical resection of diffuse low-grade gliomas (DLGGs) involving cortical eloquent areas and subcortical functional pathways represents a challenge in neurosurgery. Patient-specific, 3-dimensional (3D)-printed models of head and brain structures have emerged in recent years as an educational and clinical tool for patients, doctors, and surgical residents.[Methods] Using multimodal high-definition magnetic resonance imaging data, which incorporates information from specific task-based functional neuroimaging and diffusion tensor imaging tractography and rapid prototyping technologies with specialized software and “in-house” 3D printing, we were able to generate 3D-printed head models that were used for preoperative patient education and consultation, surgical planning, and resident training in 2 complicated DLGG surgeries.[Results] This 3D-printed model is rapid prototyped and shows a means to model individualized, diffuse, low-level glioma in 3D space with respect to cortical eloquent areas and subcortical pathways. Survey results from 8 surgeons with different levels of expertise strongly support the use of this model for surgical planning, intraoperative surgical guidance, doctor-patient communication, and surgical training (>95% acceptance).[Conclusions] Spatial proximity of DLGG to cortical eloquent areas and subcortical tracts can be readily assessed in patient-specific 3D printed models with high fidelity. 3D-printed multimodal models could be helpful in preoperative patient consultation, surgical planning, and resident training.Funding for this technical paper was received from the Instituto de Salud Carlos III-Fondo Europeo de Desarrollo Regional (PI14/01823, PI16/01575, PI18/01898, PI19/01576), Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía (CVI-02526, CTS-7685), Consejería de Salud y Bienestar Social de la Junta de Andalucía (PI-0471–2013, PE-0210–2018, PI-0459–2018, PE-0186–2019), the Fundación Alicia Koplowitz and the Spanish Ministry of Science and Innovation “Retos Colaboración” 2019 program (TC2019–007150–1). Jose Gomez-Feria Ferreiro is supported by the Spanish Ministry of Education, Culture and Sports (FPU16/03550). The Hospital Virgen del Rocío Fabrication Laboratory is partially funded by (PIN-0213–2018) 3D printing Laboratory for Andalusian Public Health Service. Juan F Martín-Rodríguez is supported by the VI-PPIT-US from the University of Seville (USE-18817-A).Peer reviewe