A. Chirianc, Giorgiana Ion, Z. Faiyad, I. Poeata


Romanian Neurosurgery (2019) XXXIII (4): pp. 417-423 
DOI: 10.33962/roneuro-2019-086 
www.journals.lapub.co.uk/index.php/roneurosurgery 

 
 

 

Current applications of 3d printing in 
neurosurgery  
 

 
A. Chiriac1, A. Iencean1, Georgiana Ion1, G. Stan2, 

S. Munteanu3, I. Poeata1 

  
1 “Gr. T. Popa” University of Medicine and Pharmacy, Iasi, ROMANIA 
2 National Institute of Materials Physics, Bucharest-Magurele, ROMANIA 
3 Transilvania University of Brasov, ROMANIA 
 

 
 

ABSTRACT 
Medical implications of 3-dimensional (3D) printing technology have progressed with 

increasingly used especially in surgical fields. 3D printing techniques are practical and 

anatomically accurate methods of producing patient specific models for medical 

education, surgical planning, training and simulation, and implants production for the 

assessment and treatment of neurosurgical diseases. This article presents the main 

directions of 3D printing models application in neurosurgery. 

 

INTRODUCTION 

Since its initial appearance in the 1980s, three-dimensional (3D) printing 

has revolutionized the practice of rapid prototyping in many areas, such 

as design, engineering and medicine. This technique consists in the 

manufacture of 3D physical models, based on computer models, by 

depositing successive layers of material in the underlying structure to 

build 3D objects. [1,3,5] Modelling by 3D printing uses either a 

thermoplastic material that hardens after it has been heated during 

extrusion, or uses a low power ultraviolet (UV) laser to solidify a liquid 

photosensitive polymer in the case of stereolithography. The 

development of this technique has allowed the elimination of 

intermediate stages of product development allowing a cheap and 

rapid transition of concepts into prototypes or finished products. 

 The numerous innovations in the field of technology and materials 

of the last decade have allowed improving the precision level of the 

printed objects and have increased the range of printable materials. 

Thus, the applications of 3D printing technology have expanded greatly 

in the medical and biomedical fields. Applications in clinical medicine 

appear especially in maxillofacial reconstructions, neurosurgery and 

spinal surgery. The ability of 3D printing to produce individualized 

models, devices and implants has greatly contributed to the 

development of so-called “personalized medicine”. In addition, the 

proven utility in surgical planning and simulation, assisting in the 

consent process and use as an educational tool have significantly 

marked the role of 3D printing in medicine [2,4,6].  

Keywords 
3D printing, 

neurosurgery, 
3D models  

 
 

 
 

Corresponding author: 
A. Chiriac 

 
“Gr. T. Popa” University of Medicine 

and Pharmacy, Iasi, Romania 
 

chiriac_a@hotmail.com 
 
 

 
 

Copyright and usage. This is an Open Access 
article, distributed under the terms of the Creative 
Commons Attribution Non–Commercial No 
Derivatives License (https://creativecommons 
.org/licenses/by-nc-nd/4.0/) which permits non-
commercial re-use, distribution, and reproduction 
in any medium, provided the original work is 
unaltered and is properly cited. 
The written permission of the Romanian Society of 
Neurosurgery must be obtained for commercial 
re-use or in order to create a derivative work. 
 

 
ISSN online 2344-4959 
© Romanian Society of 

Neurosurgery 
 

 
 

First published 
December 2019 by 

London Academic Publishing 
www.lapub.co.uk 

 

http://www.lapub.co.uk/


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A. Chiriac, A. Iencean, Georgiana Ion, et al. 

3D PRINTING EVOLUTION IN NEUROSURGERY 

In the field of neurosurgery, the 3D printing 

technique has made substantial progress since 2007 

as a result of the development of cranioplasty 

techniques that required the implementation of 

implants with increasingly complex anatomical 

configurations. Initially, the evolution of this 

technique was limited as the commercially available 

printers were still in the beginning and allowed 

printing only in one material and density. 

Subsequently, 3D printing has progressed, following 

the success of making models with as accurate 

spatial representations of the patient's anatomy. 

Thus, with the development in 2012 of printers with 

the possibility of printing in several materials and 

densities (Shore value), the technique of 3D printing 

in neurosurgery has developed in several main 

directions: - development of anatomical models 

specific to the patient for surgical planning; - 

vocational training and education; - design of 

neurosurgical devices for the evaluation and 

treatment of neurosurgical diseases; - and not least, 

the development of biological tissue implants. In this 

article, we will review the achievements of 3D 

printing in every direction in the neurosurgery field 

to evaluate the usefulness of final products, the 

challenges encountered and the progress of the field 

[1,5,7]. 

 

CRANIOPLASTY (RECONSTRUCTION OF SKULL DEFECTS) 

Cranioplasty is one of the oldest neurosurgical 

procedures, practiced since 3000 BC. The most 

common defects of the skull can appear after 

trauma, neurosurgical procedures such as 

decompressive craniotomy, tumor resections with 

bone invasion, infections and congenital defects. The 

purpose of the cranial repair is to protect the 

underlying brain tissue, to reduce the local pain, to 

restore the patient's psychological balance by 

improving the cranial aesthetics.  

 The materials used initially in the cranioplasty 

procedure were pieces of autologous bone, 

polymeric, ceramic and metallic biomaterials. These 

autologous bones represented by the autologous 

calvarial bone removed from the patient during the 

initial operation had long-term problems, including 

subsidence, disintegration and infection. Thus, in a 

large number of patients, these plates disintegrated 

following their re-implantation, creating large 

defects, often accompanied by pain at the edges of 

the disintegrated defect. Subsequently, autologous 

bones were excluded and various acrylic or metal-

based materials became increasingly used in cranial 

reconstructions. One of the disadvantages of these 

materials is the need to model them in situ during 

the operation, usually manually or with minimal 

equipment. These had to be cut and bent to fit, often 

reaching with sharp edges that represented a risk to 

both the surgeon and the patient's overlapping skin. 

All of these resulted in an extension of the 

intervention time and also created a number of 

problems, including poor match and unsatisfactory 

cosmetic result. 

 

 
 

Figure 1: PMMA reconstruction on 3D printed model 

  

With the advent of 3D printing, most of the problems 

mentioned above have managed to be overcome. 

Initially the 3D printing method was used to create a 

mould model on which the reconstruction joints are 

prefabricated. Also, another approach consisted in 

the initial creation of some models in the corrected 

form, and the titanium plates were subsequently 

modelled to suit the defect based on reconstruction. 

Implants thus reconstructed were then tested on the 

3D printed model of the defect before sterilization 

and surgery. In addition to titanium, other materials 

such as acrylic (PMMA) and PEEK (polyether ether 

ketone) have also been used to create implants using 

similar techniques (figure 1). The use of these 

materials allowed the creation of a personalized 

prosthesis using 3D printing moulds characterized 

by an excellent cranial contour. Using the standard 

printing method described above, it was possible to 

avoid the possibility of deterioration of adjacent 

tissues due to the exothermic reaction during the 

polymerization process. Thus, intraoperative 



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Current applications of 3d printing in neurosurgery 

modelling of the final implant can be performed in 

just a few minutes [1,6,7,8,9]. 

 The introduction of the 3D printing technique by 

the continuos multilayer deposition method in 

obtaining the cranioplasty implants determined the 

elimination of the intraoperative manipulation 

through cutting and modeling. 

 As the geometry of the facial bones and skull is 

extremely complex and most of these defects 

primarily involve underlying bone structures, the 

application of this more advanced 3D printing 

technology has proven ideal. 

 

NEUROSURGICAL TRAINING 

Surgical training is usually a multi-step process by 

which the trainee acquires knowledge and skills of 

practicing surgical procedures. Thus, as the trainee 

gains skills, he will be able to progress to more 

complex steps and be given more autonomy. The 

effectiveness of this learning model can be 

influenced by the existence of the teaching material 

(most often represented by the availability of 

corpses), the number of cases and the interval of 

pathology related to a certain surgical unit. 3D 

printing offers solutions to bypass some of these 

problems and improve the internship experience. 

The trainees can practice and master the individual 

operative steps on the models before practicing with 

a real patient. This can improve learner confidence 

(especially in cases involving a difficult or unusual 

anatomy) and can help speed up the training 

timeline, as skill acquisition is achieved 

concomitantly with the actual operating experience 

of the patient. Also, the use of 3D printed models in 

vocational training helps surgical educators 

standardize the acquisition of operator skills among 

trainees. 3D printing thus offers a number of 

advantages, which allow it to be a useful adjunct to 

existing surgical simulation methods, such as 

cadaveric dissection and virtual reality techniques 

[1,2,4,7,9]. 

 

 

 

 

 

 

 

 

 
 

 

Figure 2: 3D printed models for vascular aneurysm and 

sphenoid wigs tumour intervention training.  

 

The main directions of neurosurgical pathology that 

have benefited from the advantages of 3D printing 

have been the provocative anatomy lesions, such as 

cerebral vascular malformations of the aneurysm or 

MAV, brain tumors, and techniques such as 

ventricular or transnational endoscopy, which 

involve visualization constraints. One area where 

learning has generally been limited in the operating 

room is aneurysmal blinking. With the large-scale 

introduction of the treatment of aneurysms by coil 

embolization and the lack of cadaveric tissue, 

simulation-based training has become an absolute 

must in the strategy of vascular neurosurgery 

training. Mashiko et al. using hollow elastic replicas 

of the different aneurysms from their vascular 

networks in a 3D printed model, they offered young 

neurosurgeons the opportunity to gain experience in 

selecting the appropriate clip, understanding the 

shape of the aneurysm and the direction of the clip 

[1,3,10]. 

 Similar to the field of vascular neurosurgery, the 

surgical training for excision of brain tumors has 

included the use of simulators based on anatomical 

models obtained by 3D printing (Figure 2). Thus, the 

use of 3D printers has allowed the development of 

simulators created from a multitude of materials 

with different consistencies and densities. This 

achievement contributed to the improvement of the 

simulation by replicating the handling characteristics 

of the different types of tissues [1,2,3,4]. 

 It is very well known the absolute necessity of the 

surgical training in the case of spinal pathology, 

especially due to the multitude of types of implants 

proposed at present by the specialized companies. 

The continuous evolution of the spinal implants 

correlated with the development of the 



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A. Chiriac, A. Iencean, Georgiana Ion, et al. 

instrumentation specific to each type made the 

introduction of 3D printed models inevitable in this 

area. Thus, the need for training for specialists in 

spinal neurosurgery aimed at acquiring the skills of 

use for various types of implants and 

instrumentation has greatly increased the use of 

these 3D printed models and due to the impossibility 

of access to such a large number of anatomical 

biological structures. 

 

 

 

 

 
Figure 3: 3D printed models for a meningioma approach 

training.  

 

PLANNING IN NEUROSURGICAL PATHOLOGY 

Surgical intervention for intracranial aneurysm 

requires a complete and clear understanding of the 

complex 3D structure of the aneurysms and 

individual relationships with the carrier vessels and 

adjacent branches, in addition to accurate 

knowledge of the surrounding anatomical 

structures. Despite the evolution of 3D imaging 

acquisitions and processing (3D-CTA or 3D-DSA), the 

visualization and analysis of aneurysmal and MAV 

lesions by neurosurgeons are paradoxically deprived 

of a flat-screen 2D computer, making depth 

interpretations difficult. With the advent of 3D 

printing, this approach has become a feasible option, 

which has allowed faithful 3D physical reproduction 

of the vascular networks of an individual patient 

[Figure 1]. Thus, these physical models that can be 

viewed from any angle and correctly appreciated 

dimensionally represent a potentially more 

advantageous method. Studies in the literature 

comprising both qualitative and quantitative 

evaluations did not show significant dimensional 

differences between the imaging acquisitions and 

the printed model, proving the usefulness of using 

this printing technique. Most of the discrepancies 

reported were the result of the residual support 

material from the lumen of the vessels. Namba et al. 

reported for the first time the possibility of using 

these 3D printed models for endovascular planning 

(choosing the shape of the microcatheter and the 

coils occlusion). 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Figure 4: 3D printed 

models for a calvarial 

tumour planning 

approach.  

 

Surgical planning in the resection of brain tumours 

mainly involves the use of MRI imaging. Even with the 

advantages offered by this imaging technique, the 

relationships between the tumour formation and the 



 421 
Current applications of 3d printing in neurosurgery 

adjacent anatomical elements are difficult to 

appreciate especially in the case of infiltrative ones. 

3D printing technology has allowed the translation of 

MRI imaging data into patient-specific models that 

show the associations between tumour, skull, 

vascularisation and non-pathologic brain tissue 

[Figure 4]. [5] Moreover, the use of functional MRI 

imaging allowed a much more precise surgical 

planning through a clear demarcation of the areas of 

eloquent cortex that needed to be avoided in 

microsurgical resection manoeuvres. Large complex 

models of skull and brain tissue based on MRI could 

also be used for surgical planning in the case of 

transnational or transventricular endoscopic 

approaches. In addition, these models can be used 

in the planning and development of new treatments 

for brain tumours such as noninvasive 

thermocoagulation [1,10]. 

 The identification and understanding of the 

anatomy in the case of spinal fractures is a 

fundamental component for the surgical treatment. 

CT and MRI imaging techniques, although, allow a 

good visualization of the anatomical elements or 

proved insufficient as regards the spinal 

interventional planning. This is reinforced by the 

development of intraoperative referral procedures 

used in spinal neurosurgery. Numerous specialized 

studies have shown that 3D printed representations 

of these pathological situations at the spine level are 

extremely efficient in choosing fixation and 

prosthesis systems, but also in exercise in implanting 

them especially in the case of minimally invasive 

percutaneous interventions. Thus, the detailed visual 

analysis of these 3D printed models allows a much 

clearer and more accurate dimensional and 

conformational assessment of the anatomical 

situation. This technique will allow neurosurgeons to 

establish some more precise dimensional 

parameters of the surgical implant insertion 

trajectory that can be transferred to the 

intraoperative guidance systems (Figure 5). 

 

 
 

 

 

 

 

 

 

 

 

 

 

 

Figure 5: 3D printed models for 

cervical spine planning approach.  

 

 

 

ASSISTING IN THE CONSENT PROCESS 

Any medical procedure requires informed consent 

that involves a direct communication between the 

doctor, the patient and his family regarding the 

patient's condition, the treatment possibilities, along 

with its advantages and disadvantages, the 

consequences of the non-treatment, as well as the 

risks and complications of each form of therapy. 

[1,7]. Statistical studies have shown that each step of 

informed consent can be better explained and 

understood through the use of a tangible object, in 

other words by materializing an abstract concept. 

 

 

 

 

 

 

 

 
Figure 6: Spine 3D 

printed model for 

assisting in the 

consent process. 



 422 
A. Chiriac, A. Iencean, Georgiana Ion, et al. 

The use of 3D printed models proved to be very 

useful in the patient's consent procedure by 

considerably improving the discussions with them, 

due to the much clearer explanations of the 

proposed pathology and interventions. Thus, 

physicians can use customized physical models with 

in situ pathology for each individual patient. The 

stages of the surgery as well as the possible specific 

complications are much better explained to the 

nonmedical staff through physical models. Also, 

these 3D printed models help to better understand 

the disease and the results of the treatment, thus 

reducing the patient's uncertainty about the medical 

act, preventing complaints, discontents and 

accusations of malpractice (Figure 6) [7,8]. 

 

MEDICAL EDUCATION 

The use of 3D printed models has proven to be an 

extremely useful teaching tool for both students in 

the anatomy discipline, and surgical disciplines as 

well as for residents in the neurosurgery specialty. 

3D printing techniques offer significant advantages 

in the process of medical education within the 

university and postgraduate programs, compared to 

the existing methods of anatomical modelling, which 

include cadaveric dissection, plastic models and 

plastinated corpus specimens. Although traditionally 

medical education in the field of anatomy and 

surgery was provided primarily by cadaveric 

dissection, this learning mode was associated with 

difficulties related to the costs of setting up and 

maintaining an anatomical dissection laboratory, the 

existence of a sufficient number of bodies for 

educational programs, safety issues for students and 

staff, and last but not least ethical issues with the use 

of cadaveric material. 
 

 

 
 

Figure 7: 3D printed models for student medical education 

[10]. 

 

The use of plastic models as an adjunct to cadaveric 

dissection to demonstrate certain organs or skeletal 

anatomy is limited by their lack of anatomical realism 

and the lack of representation of the variation or 

pathology specific to the patient. In contrast, 3D 

printing techniques allow the production of precise 

models characterized by a great variability and 

particular anatomical normality, but also 

pathological. Unlike plastination, which presents the 

major disadvantage of the resources required to 

create anatomical models, 3D printing does not limit 

the amount of 3D printed models produced, 

depending on the number of original copies (Figure 

7). 

 Studies published in the literature have already 

shown improvements in the scores of anatomy tests 

of medical students after using 3D printing in the 

learning process. Thus, 3D printed models offer 

viable solutions for the vast majority of the 

difficulties faced by educators using more traditional 

training methods [1,5,10]. 

 

CONCLUSIONS 

The technique of 3D printing has undergone a 

remarkable development and use in the field of 

neurosurgery in the last decade. The possibility 

offered by this rapid prototyping technology 

provides a practical and anatomically precise means 

of producing patient‑specific and disease‑specific 



 423 
Current applications of 3d printing in neurosurgery 

models. Besides applications already known in the 

fields of education and anatomical modelling, 

surgical planning, simulation and training, the 

creation of personalized implants for the treatment 

of various neurosurgical pathologies represents the 

real challenge of these technologies. Thus, extending 

this technology in neurosurgery will serve both 

medical students and interventionist, but especially 

to patients. 

 

 

This study about 3D printing applications in 

neurosurgery is the subject of the grant: "New 

diagnostic and treatment methodologies: current 

challenges and technological solutions based on 

nanoparticles and biomaterials", that won the 2017 

complex projects completed in consortia CDI, grant 

number: PN-III-P1-1.2-PCCDI-2017-0062, funded by 

CNCS – UEFISCDI Romania. 
 

 

 

REFERENCES 

1. Baskaran, V., Štrkalj, G., Štrkalj, M., & Di Ieva, A. (2016). 

Current applications and future perspectives of the use of 

3D printing in anatomical training and neurosurgery. 

Frontiers in neuroanatomy, 10, 69. 

2. Klein, G. T., Lu, Y., & Wang, M. Y. (2013). 3D printing and 

neurosurgery--ready for prime time?. World neurosurgery, 

80(3-4), 233-235. 

3. Ploch, C. C., Mansi, C. S., Jayamohan, J., & Kuhl, E. (2016). 

Using 3D printing to create personalized brain models for 

neurosurgical training and preoperative planning. World 

neurosurgery, 90, 668-674. 

4. Pucci, J. U., Christophe, B. R., Sisti, J. A., & Connolly Jr, E. S. 

(2017). Three-dimensional printing: technologies, 

applications, and limitations in neurosurgery. 

Biotechnology Advances, 35(5), 521-529. 

5. Randazzo, M., Pisapia, J. M., Singh, N., & Thawani, J. P. 

(2016). 3D printing in neurosurgery: a systematic review. 

Surgical Neurology International, 7(Suppl 33), S801. 

6. Rybicki, F. J., & Grant, G. T. (2017). 3D Printing in Medicine. 

Cham: Springer International Publishing. 

7. Tevanov, L., Liciu, E., Chirila, M. O., Dusca, A., & Ulici, A. 

(2017). The use of 3D printing in improving patient-doctor 

relationship and malpractice prevention. Rom J Leg Med, 

25(3). 

8. Tomasello, F., Conti, A., & La Torre, D. (2016). 3D printing in 

Neurosurgery. 

9. Vakharia, V. N., Vakharia, N. N., & Hill, C. S. (2016). Review of 

3-dimensional printing on cranial neurosurgery simulation 

training. World neurosurgery, 88, 188-198. 

10. Waran, V., Narayanan, V., Karrupiah, R., & Cham, C. Y. 

(2017). 3D Printing in Neurosurgery. In 3D Printing in 

Medicine (pp. 51-58). Springer, Cham. 

11. https://anatomywarehouse.com/3d-printed-head-neck-

and-shoulder-with-angiosomes-a-105328.