title: Review of 3-Dimensional Printing on Cranial Neurosurgery Simulation Training.
abstract: OBJECTIVE
  Shorter working times, reduced operative exposure to complex procedures, and increased subspecialization have resulted in training constraints within most surgical fields. Simulation has been suggested as a possible means of acquiring new surgical skills without exposing patients to the surgeon's operative "learning curve." Here we review the potential impact of 3-dimensional printing on simulation and training within cranial neurosurgery and its implications for the future.
  
  
  METHODS
  In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive search of PubMed, OVID MEDLINE, Embase, and the Cochrane Database of Systematic Reviews was performed.
  
  
  RESULTS
  In total, 31 studies relating to the use of 3-dimensional (3D) printing within neurosurgery, of which 16 were specifically related to simulation and training, were identified. The main impact of 3D printing on neurosurgical simulation training was within vascular surgery, where patient-specific replication of vascular anatomy and pathologies can aid surgeons in operative planning and clip placement for reconstruction of vascular anatomy. Models containing replicas of brain tumors have also been reconstructed and used for training purposes, with some providing realistic representations of skin, subcutaneous tissue, bone, dura, normal brain, and tumor tissue.
  
  
  CONCLUSIONS
  3D printing provides a unique means of directly replicating patient-specific pathologies. It can identify anatomic variation and provide a medium in which training models can be generated rapidly, allowing the trainee and experienced neurosurgeon to practice parts of operations preoperatively. Future studies are required to validate this technology in comparison with current simulators and show improved patient outcomes.
authors.affiliation: Department of Neurosurgery, Royal London Hospital, Whitechapel, United Kingdom. Electronic address: v.n.vakharia@doctors.org.uk.
authors.forename: Vejay N
authors.initials: VN
authors.lastname: Vakharia
authors.affiliation: Department of Neurosurgery, Royal London Hospital, Whitechapel, United Kingdom.
authors.forename: Nilesh N
authors.initials: NN
authors.lastname: Vakharia
authors.affiliation: Department of Neurosurgery, Royal London Hospital, Whitechapel, United Kingdom.
authors.forename: Ciaran S
authors.initials: CS
authors.lastname: Hill
mesh_terms: D001921:Brain / Q000033:anatomy & histology* / Q000601:surgery*; D003399:Craniotomy / Q000193:education* / Q000295:instrumentation; D006801:Humans; D008953:Models, Anatomic; D009493:Neurosurgery / Q000193:education*; D066230:Patient-Specific Modeling; D066330:Printing, Three-Dimensional
keywords: 3-Dimensional printing; Education; Neurosurgery; Simulation; Training