European Archives of Oto-Rhino-Laryngology

, Volume 272, Issue 3, pp 753–757 | Cite as

Endoscopic skull base training using 3D printed models with pre-existing pathology

  • Vairavan NarayananEmail author
  • Prepageran Narayanan
  • Raman Rajagopalan
  • Ravindran Karuppiah
  • Zainal Ariff Abdul Rahman
  • Peter-John Wormald
  • Charles Andrew Van Hasselt
  • Vicknes Waran


Endoscopic base of skull surgery has been growing in acceptance in the recent past due to improvements in visualisation and micro instrumentation as well as the surgical maturing of early endoscopic skull base practitioners. Unfortunately, these demanding procedures have a steep learning curve. A physical simulation that is able to reproduce the complex anatomy of the anterior skull base provides very useful means of learning the necessary skills in a safe and effective environment. This paper aims to assess the ease of learning endoscopic skull base exposure and drilling techniques using an anatomically accurate physical model with a pre-existing pathology (i.e., basilar invagination) created from actual patient data. Five models of a patient with platy-basia and basilar invagination were created from the original MRI and CT imaging data of a patient. The models were used as part of a training workshop for ENT surgeons with varying degrees of experience in endoscopic base of skull surgery, from trainees to experienced consultants. The surgeons were given a list of key steps to achieve in exposing and drilling the skull base using the simulation model. They were then asked to list the level of difficulty of learning these steps using the model. The participants found the models suitable for learning registration, navigation and skull base drilling techniques. All participants also found the deep structures to be accurately represented spatially as confirmed by the navigation system. These models allow structured simulation to be conducted in a workshop environment where surgeons and trainees can practice to perform complex procedures in a controlled fashion under the supervision of experts.


Base of skull surgery Odontoid ENT-ORL Simulation Training Clinical skills 3D rapid prototyping 



This work was supported by University of Malaya via the High Impact Research Grant (H-50001-00-A000026) granted to Professor Vicknes Waran. Neither University Malaya nor the grant committee had a direct role in the study design; collection, analysis or interpretation of data; writing of the report; and the decision to submit this paper for publication.

Conflict of interest

None declared.

Supplementary material

Video 1: Demonstration of odontoid drilling in the model (MPG 7596 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Vairavan Narayanan
    • 1
    Email author
  • Prepageran Narayanan
    • 2
  • Raman Rajagopalan
    • 2
  • Ravindran Karuppiah
    • 1
  • Zainal Ariff Abdul Rahman
    • 3
  • Peter-John Wormald
    • 5
  • Charles Andrew Van Hasselt
    • 4
  • Vicknes Waran
    • 1
  1. 1.Division of Neurosurgery, Department of Surgery, Faculty of MedicineUniversity MalayaKuala LumpurMalaysia
  2. 2.Department of ORLUniversity MalayaKuala LumpurMalaysia
  3. 3.Department of Maxillofacial SurgeryUniversity MalayaKuala LumpurMalaysia
  4. 4.Department of Otorhinolaryngology, Head and Neck SurgeryThe Chinese University of Hong KongHong KongHong Kong
  5. 5.Department of Surgery-Otolaryngology Head and Neck SurgeryUniversity of AdelaideAdelaideAustralia

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