title: A critical inventory of preoperative skull replicas.
abstract: BACKGROUND
  Physical replicas of organs are used increasingly for preoperative planning. The quality of these models is generally accepted by surgeons. In view of the strong trend towards minimally invasive and personalised surgery, however, the aim of this investigation was to assess qualitatively the accuracy of such replicas, using skull models as an example.
  
  
  METHODS
  Skull imaging was acquired for three cadavers by computed tomography using clinical routine parameters. After digital three-dimensional (3D) reconstruction, physical replicas were produced by 3D printing. The facsimilia were analysed systematically and compared with the best gold standard possible: the macerated skull itself.
  
  
  RESULTS
  The skull models were far from anatomically accurate. Non-conforming rendering was observed in particular for foramina, sutures, notches, fissures, grooves, channels, tuberosities, thin-walled structures, sharp peaks and crests, and teeth.
  
  
  CONCLUSIONS
  Surgeons should be aware that preoperative models may not yet render the exact anatomy of the patient under consideration and are advised to continue relying, in specific conditions, on their own analysis of the native computed tomography or magnetic resonance imaging.
authors.affiliation: University of Geneva, Switzerland; Clinical Anatomy Research Group, Department of Cellular Physiology and Metabolism, University Medical Center, Rue Michel-Servet 1, 1211 Geneva 4, Switzerland. jean.fasel@unige.ch.
authors.forename: J H D
authors.initials: JH
authors.lastname: Fasel
authors.forename: J
authors.initials: J
authors.lastname: Beinemann
authors.forename: K
authors.initials: K
authors.lastname: Schaller
authors.forename: P
authors.initials: P
authors.lastname: Gailloud
mesh_terms: D016477:Artifacts; D002102:Cadaver; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000592:standards*; D008953:Models, Anatomic; D011300:Preoperative Care; D012886:Skull / Q000033:anatomy & histology*; D014057:Tomography, X-Ray Computed
references.citation: Ann Thorac Surg. 2012 Feb;93(2):e31-3
references.pmid: 22269765
references.citation: Clin Implant Dent Relat Res. 2012 Jun;14(3):442-53
references.pmid: 20156227
references.citation: Int J Oral Maxillofac Surg. 2002 Feb;31(1):23-32
references.pmid: 11936396
references.citation: Oral Maxillofac Surg Clin North Am. 2010 Feb;22(1):117-34
references.pmid: 20159482
references.citation: J Bone Joint Surg Am. 2003;85-A Suppl 4:49-55
references.pmid: 14652393
references.citation: Acad Radiol. 2011 Apr;18(4):461-70
references.pmid: 21216631
references.citation: Int J Oral Maxillofac Surg. 2010 Feb;39(2):182-4
references.pmid: 20064702
references.citation: J Oral Maxillofac Surg. 2005 Jul;63(7):1006-15
references.pmid: 16003630
references.citation: Int J Comput Assist Radiol Surg. 2010 Jul;5(4):335-41
references.pmid: 20467825
references.citation: J Pediatr Orthop. 2007 Dec;27(8):955-60
references.pmid: 18209623
references.citation: J Craniomaxillofac Surg. 2009 Apr;37(3):167-73
references.pmid: 19056288