This work is supported by grants from Natural Science Fund of Guangdong Province (No. 2017A030313597) and Southern Medical University (No. LX2016N006, No. KJ20161102).

1. Drawing a two dimensional (2D)-image of a burr hole ring
<ol>
	<li>Open the 2D computer aided design (CAD) software and then create a graphical document.</li>
	<li>Click Draw | Line and draw a reference point with a solid line on the drawing. Click Modify | Offset, and type the specific offset distance in the command line.</li>
	<li>Click on the object and press by the left mouse button to create a solid line. Click Modify | Trim, select the area to be trimmed and c...

<ol>
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L., Tagliati, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=STN-DBS+frequency+effects+on+freezing+of+gait+in+advanced+Parkinson+disease.">STN-DBS frequency effects on freezing of gait in advanced Parkinson disease.</a> Neurology. 72 (8), 770 (2009).</li><li>Moreau, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=STN-DBS+frequency+effects+on+freezing+of+gait+in+advanced+Parkinson+disease.">STN-DBS frequency effects on freezing of gait in advanced Parkinson disease.</a> Neurology. 71 (2), 80-84 (2008).</li><li>Oyama, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Unilateral+GPi-DBS+as+a+treatment+for+levodopa-induced+respiratory+dyskinesia+in+Parkinson+disease.">Unilateral GPi-DBS as a treatment for levodopa-induced respiratory dyskinesia in Parkinson disease.</a> Neurologist. 17 (5), 282-285 (2011).</li></ol>

These results showed that the software used were practicable to build 3D models of burr hole rings (Figure 1 and Figure 2), and 3D printing can be used to build solid models with designated materials (Figure 4). In terms of the size of the solid model, there was an absolute error from 0 to 0.59 mm determined through the measurement made by Vernier calipers (Figure 6). To some extent, the error is unavoi...

3D printing has been applied in the medical field since the 1980s, especially in surgery for preoperative simulation, anatomical learning and surgical training1. For example, in cerebrovascular operations, preoperative simulation can be conducted by using 3D printed vascular models2. With the development of 3D printing, the texture, temperature, structure and weight of cerebral blood vessels can be simulated to the greatest extent of clinical scenarios. Trainees can perform surgical operations such as cutting and clamping on such models. This training is very important for the surgeons3,4,5. Currently, titanium patches formed by 3D printing have also gradually been applied6, since the skull prostheses developed by 3D printing after imaging and reconstruction are highly conformal. However, the development and application of 3D printing in neurosurgery is still limited.
The burr hole ring, as a part of the lead fixation device, has been widely used in deep brain stimulation (DBS)7,8,9,10. However, current burr hole rings are made by medical device manufacturers according to the unified specifications and dimensions. This standard burr hole ring is not always suitable for all conditions, such as skull malformation and scalp atrophy. It may increase the uncertainties of operation and reduce the acurracy. The emergence of 3D printing makes it possible to develop individualized burr hole rings for patients in clinical scenarios5. At the same time, the burr hole ring, which is not easy to obtain, is not conducive to extensive preoperative demonstration and surgical training1.
To address the problems mentioned above, we proposed to construct a burr hole ring with 3D printing. A previous study in our lab described an innovative burr hole ring for DBS11. In this study, this innovative burr hole ring will be regarded as an excellent example to exhibit the detailed production process. Therefore, the purpose of this study is to provide a modeling process and a detailed technical process of building a solid burr hole ring using 3D printing.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Adobe Photoshop Version 14.0</td>
			<td>Adobe System&#65292;US</td>
			<td>_</td>
			<td>Only available with a paid subscription.</td>
		</tr>
		<tr>
			<td>Allcct 3D printer</td>
			<td>Allcct technology co., LTD, WuHan, China</td>
			<td>201807A794124CN</td>
			<td></td>
		</tr>
		<tr>
			<td>Allcct_YinKe_V1.1</td>
			<td>Allcct technology co., LTD, WuHan, China</td>
			<td></td>
			<td>The software is provided by the 3D printer manufacturer and there is no Catalog number associated with it</td>
		</tr>
		<tr>
			<td>AutoCAD 2004</td>
			<td>Autodesk co., LTD&#65292;US</td>
			<td>666-12345678</td>
			<td>Software for 2D models</td>
		</tr>
		<tr>
			<td>Carbon Fibre</td>
			<td>Allcct technology co., LTD, WuHan, China</td>
			<td>PLA175&#216;5181&#216;3&#216;B</td>
			<td>The material is provided by the 3D printer manufacturer</td>
		</tr>
		<tr>
			<td>Netfabb Studio Basic 4.9</td>
			<td>Autodesk co., LTD&#65292;US</td>
			<td>-</td>
			<td>The software is provided by a 3D printer manufacturer and is open to access</td>
		</tr>
		<tr>
			<td>Pro/E 2001</td>
			<td>Parametric Technology Corporation, PTC, US</td>
			<td>_</td>
			<td>Software for 3D models; Only available with a paid subscription.</td>
		</tr>
		<tr>
			<td>Vernier caliper&#160;</td>
			<td>&#160;Beijing Blue Light Machinery Electricity Instrument Co,. LTD, China</td>
			<td>GB/T&#8194;1214.1-1996&#8194;</td>
			<td></td>
		</tr>
	</tbody>
</table>

application of 3d printing in the construction of burr hole ring for deep brain stimulation implants

3D printing has been widely applied in the medical field since the 1980s, especially in surgery, such as preoperative simulation, anatomical learning and surgical training. This raises the possibility of using 3D printing to construct a neurosurgical implant. Our previous works took the construction of the burr hole ring as an example, described the process of using softwares like computer aided design (CAD), Pro/Engineer (Pro/E) and 3D printer to construct physical products. That is, a total of three steps are required, the drawing of 2D-image, the construction of 3D-image of burr hole ring, and using a 3D printer to print the physical model of burr hole ring. This protocol shows that the burr hole ring made of carbon fiber can be rapidly and accurately molded by 3D printing. It indicated that both CAD and Pro/E softwares can be used to construct the burr hole ring via integrating with the clinical imaging data and further applied 3D printing to make the individual consumables.

Three views of 2D images were built through commercial CAD software (see the Table of Materials). In these images, practical size and technical requirements have also been added (Figure 1). Further, three-dimensional data were constructed in (Figure 2) and saved in STL format (Figure 3). As presented in Figure 4, solid parts were built on the platform of...

Watch this Scientific Journal Video about Application of 3D Printing in the Construction of Burr Hole Ring for Deep Brain Stimulation Implants at JoVE.com

Application of 3D Printing in the Construction of Burr Hole Ring for Deep Brain Stimulation Implants

Here, we present a protocol to demonstrate 3D printing in the construction of deep brain stimulation implants.

3D printing has been widely applied in the medical field since the 1980s, especially in surgery, such as preoperative simulation, anatomical learning and ...

3D printing make possible to develop individualized burr hole rings for patients. Our protocol provide the detailed procedures for using 3D model program to construct these implants. 3D printing objects have a high product efficiency, a low cost and are customizable.With the help of 3D printing, patients can obtain implants that are highly specific to their individual needs. To draw a 2D image of a burr hole ring, open a new graphical document in the 2D CAD software program. Click Draw and Line and draw a reference point with a solid line on the drawing.Then click Modify and Offset and type the specific offset distance in the command line. To select the area to be trimmed, click Modify and Trim and click the extra line. To draw the top view, click Draw and Line to construct the reference point and click Daw, Circle and Center Diameter to input the quantitative value of the specific radius of the circle or diameter in the command window.Then click the center of the reference point to form a circle. Next, draw the left view of the inner burr hole ring using the same approach as that for the front view. Click Dimension and Diameter and click on the circumference to mark the diameter of the circle.Click on Dimension and Linear to mark the length and thickness of all of the associated structures. Then click Dimension and Radius to mark the angle of the chamber. Using the same protocol, construct 2D drawings of the outer burr hole ring and mark the actual size and the labeling.Then click Save to save the 2D image of the burr hole ring. To draw a 3D image of the burr hole ring, open the 3D drawing software program and select the front plane as the sketch plane. Click Default under Sket view and select the dotted line tool to draw the top section of the part in the two-dimensional sketch.Click Conform and Done and click the datum plane icon. In the menu manager, select Create, Solid, Add Sheet, Rotate and Done. Then click Bilateral in the Properties menu and click Done.To construct the cross-section of the hook of the outer burr hole ring, click Front, Forward, Default, Datum Plane and Dotted Line. Click Confirm and Done and enter 50 in angle and indicated direction 45 and click Done in the protrusion. Then click the coloring button.Next select Redefine in the part feature and click the line structure of the hook. Select Section, Define and Sketch. Click the dotted line icon.Create two square embossments on the hook section, click OK, Done and Coloring. Click the datum access icon and click Insert a Datum and Cross. Click the center axis of the line structure.Click angle in the datum plane and click the front plane in the line structure view. Then click Input Value in the Offset menu and enter minus 45 in angle and indicated direction 45. Click Features, Copy and Mirror.Click the hook as the object and click Done Select and Done. Click the datum plane to complete the copy and copy the remaining two hooks in the same manner. Then click Create Concentric Circle to construct a circle with a radius of 7.23 millimeters and click the segmentation of primitives at selected points icon to remove the unnecessary lines of the circle.To create a complete outer wall section, click the solid line button and click OK and Done. Enter four as the enter depth and click Coloring. Click Mirror and Done.Click the object and Done. Then click the datum plane to complete the copy. To confirm, click Copy, Mirror and Done and select two outer walls in different directions.Then click Done and click the datum plane to complete the copy. To enhance the graphic details, click View, Model Settings, Color and Appearance, Add and adjust the RGB color slider to brown. Then click Close, Settings and OK.Click the Eliminating Hidden Lines button and click the Create Concentric Circle.Continue to create an outer edge on the outer wall and click the Segmentation of Primitives at Selected Points button to remove excess lines. Click the Solid Line button to connect the newly added outer edge into a complete section and click OK.Enter 0.8 as the enter depth and click OK in the protrusion window. In the menu manager, click Copy, Mirror, Done, click the object and click Done.Click Generate Benchmark and Offset and click the input value in Offset. Then enter 0.4 as the isometric of the specified direction and click Done. Click Copy, Mirror and Done and click the outer wall.To complete the mirror operation of the outer wall and the square embossing, click Done Select and Done and click the datum of the image to complete the copy. Select File and Copy and save the file in stl format. Enter the part number and click OK.Then in the output STL dialogue box, adjust the cord height to 006 and the angle control to 0.00001, click Apply and OK.To print the rings, open the project files in the model detecting software.Confirm that the outer ring is complete and click Part, Export Part as STL and Save. Following model detection, open the slicing software and click File and Load Model File and open one stl file. Click the left mouse button to select the moving track of the part and adjust the position of parts.Set the print speed to 30 millimeters per second, the printing temperature to 210 degrees Celsius and the bed temperature to 80 degrees Celsius. Then click Tool Path to SD to save the file in G-code format and to generate the printed path. When the temperature rises to the preset value, click Print and select the target file and Confirm to start printing.After the bottom supporting grid has been constructed, the printing nozzle will begin to construct the outer ring vertically, layer by layer. After the outer ring is formed, the printer nozzle will print the inner ring on the right side. After both rings have cooled, remove the models from the platform.Here, the absolute error and error range were calculated for five groups of parts that were produced as demonstrated. The results indicate that in the outer ring, the maximum absolute error and minimum absolute error were found in the outside diameter of the waist and in the thickness of the top respectively. In the inner ring, the maximum absolute error and the minimum absolute error were found in the inside diameter and in the thickness of the top respectively.The total error range was 0.00, 0.59.3D and MR data has a potential to be used to build the actual imaging of the burr hole rings if the thick can be extract from images. Our protocol provides a rapid and accurate method for constructing deep brain stimulation implants through the integration of clinical imaging data and 3D printing.

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6.7K visualizações.  Southern Medical University. A impressão 3D possibilita o desenvolvimento de anéis de orifícios de rebarba individualizados para os pacientes. Nosso protocolo fornece os procedimentos detalhados para o uso do programa modelo 3D para construir esses implantes. Os objetos de impressão 3D têm uma alta eficiência do produto, um baixo custo e são personalizáveis.Com a ajuda da impressão 3D, os pacientes podem obter implantes altamente específicos para suas necessidades individuais. Para desenhar uma imagem 2D...