Development of a CT-compatible anthropomorphic skull phantom for surgical planning, training and simulation

Neurosurgical procedures require high accuracy and skills, so that practical surgical training is a key factor for successful patient outcomes. Neurosurgical training has been traditionally performed on human cadavers, or more recently on simulation models including virtual reality (VR) platforms. However, these methods have several drawbacks, including ethical and practical concerns. Anthropomorphic phantoms could solve most of the issues related to cadaveric models, and are suitable for simulating several neurosurgical procedures. The aim of this study was to design a realistic and CT-compatible anthropomorphic head phantom that could be used for surgical training and simulation, with a specific focus on endo-nasal skull-base surgery and brain biopsy. A head phantom was created by segmenting a Cone Beam Computed Tomography (CBCT) image and a T1-weighted MR image from a cadaver. The skull, which includes a complete structure of the nasal cavity and detailed skull-base anatomy, is 3D printed using PLA with calcium. The brain phantom is produced using a 3D printed mold, casting a mixture of PVA, water and coolant. The radiodensity and mechanical properties of the phantom were tested and adjusted in material choice to mimic real-life conditions. In general, surgeons have a positive attitude in using the phantom. The skull and the eloquent structures at the skull-base, as well as the brain parenchyma were realistically reproduced. The head phantom can be employed for neurosurgical education, training and surgical planning, and can be successfully used for simulating endo-nasal skull-base surgery and brain biopsies.