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Surgical simulation has become a critical component of surgical practice and training in the era of high-precision image-guided
surgery. While the ability to simulate surgery of the paranasal sinuses and skull base has been conventionally
limited to 3D digital simulation or cadaveric dissection, we have developed novel methods employing rapid prototyping
technology and 3D printing to create high-fidelity models from real patient images (CT or MR). Such advances allow
creation of patient-specific models for preparation, simulation, and training before embarking on the actual surgery. A
major challenge included the development of novel material formulations compatible with the rapid prototyping process
while presenting anatomically realistic flexibility, cut-ability, drilling purchase, and density (CT number). Initial studies
have yielded realistic models of the paranasal sinuses and skull base for simulation and training in image-guided surgery.
The process of model development and material selection is reviewed along with the application of the phantoms in
studies of high-precision surgery guided by C-arm cone-beam CT (CBCT). Surgical performance is quantitatively
evaluated under CBCT guidance, with the high-fidelity phantoms providing an excellent test-bed for reproducible
studies across a broad spectrum of challenging surgical tasks. Future work will broaden the atlas of models to include
normal anatomical variations as well as a broad spectrum of benign and malignant disease. The role of high-fidelity
models produced by rapid prototyping is discussed in the context of patient-specific case simulation, novel technology
development (specifically CBCT guidance), and training of future generations of sinus and skull base surgeons.
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