Suitable materials for the creation of neurosurgical phantoms using the example of a 3D printed simulation model of the posterior fossa

Suitable materials for the creation of neurosurgical phantoms using the example of a 3D printed simulation model of the posterior fossa | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Method Article Suitable materials for the creation of neurosurgical phantoms using the example of a 3D printed simulation model of the posterior fossa Svenja Jung, Maike Stummer, Erdem Güresir, Dirk Winkler, Ronny Grunert, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6991325/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background In the preceding 15 years, the implementation of 3D printing has undergone a steady increase across a variety of disciplines. In the medical domain, its use has become particularly prominent, for instance in the development of anatomical phantoms to visualize pathological conditions or to evaluate new surgical procedures. In order to identify a material that specifically mimics cranial bone, a literature review of existing skull phantoms was conducted. This was followed by a pilot study using a custom-developed phantom of the posterior fossa for the evaluation of a suitable material. Methods A literature search was conducted using the PubMed database for existing 3D printed skull phantoms. The search terms "3D printed," "skull phantom," and "neurosurgery," among others, were utilized. A total of 1,741 publications were identified in the initial review. The initial pool of articles was then narrowed down based on several inclusion criteria, including language. For the experimental study on the phantom, test blocks made from various materials were produced and subjected to craniotomy procedures. The materials were evaluated by an experienced neurosurgeon based on their drilling characteristics. The highest-rated material (White V4 resin by Formlabs) was selected for the fabrication of the final skull phantom. Results A total of 68 articles satisfied the inclusion criteria and were thus included in the analysis. The results indicated that approximately half of all phantoms, irrespective of their intended application, were fabricated using PLA. Subsequent to this, ABS and various resins from Formlabs were introduced. For the material evaluation study, nine neurosurgeons were tasked with performing a craniotomy on the phantom and assessing the material in comparison to real bone. The material (White V4 by Formlabs) was evaluated using a self-selected Likert scale, resulting in an average rating of 7.2 out of 10 points. This rating indicates that the material is deemed suitable. Conclusion The findings demonstrate that the materials used for the fabrication of skull phantoms vary significantly depending on multiple factors. However, the material testing conducted in this study led to the identification of a resin that offers favorable properties both in terms of manufacturing feasibility and cost-efficiency. This material can effectively serve as a bone substitute for neurosurgical training purposes. The results of this study may serve as a foundation for the future development of skull models, particularly in contexts where drilling characteristics similar to those of real bone are desired. 3D print 3D printed head phantom neurosurigal phantom head phantom phantom additve manufacturing Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Background In the past 15 years, there has been an exponential increase in the number of publications focusing on the topic of 3D printing [ 1 ]. This development spans a wide range of sectors, including architecture, the automotive and toy industries, as well as biology and medicine. The field of medicine offers a vast spectrum of applications, including implants [ 2 , 3 ], orthoses [ 4 , 5 ], and prostheses [ 6 , 7 ]. Another significant domain of application pertains to phantoms or simulation models, which can be utilized, for instance, to represent various anatomical structures or to evaluate novel therapeutic approaches and surgical instruments. In this context, it is imperative to reproduce the relevant anatomical region as realistically as possible to ensure the validity and clinical relevance of such tests. Consequently, the identification of 3D printable materials capable of accurately replicating specific anatomical structures is of particular interest. This would facilitate the development of simplified yet realistic models of organs such as the liver, brain, or bone. Given our proximity to the field of neurosurgery, the replication of the brain and skull is of significant importance. This is particularly salient in the case of the skull, which is opened in virtually all neurosurgical procedures. It is imperative that this structure be replicated with the utmost fidelity when designing a simulation model. This ensures that the training scenario closely resembles actual surgical conditions. The objective of this study was twofold: first, to conduct a comprehensive literature review of skull models produced via 3D printing over the past 15 years, with a particular focus on the materials used. In light of the findings from this review, and in consideration of the 3D printers and materials at our disposal, we initiated an experimental study. In the preliminary phase, a series of materials were evaluated through simulated craniotomies to ascertain which material most closely replicates the mechanical properties of authentic bone. In the subsequent phase, a phantom was fabricated using the most suitable material. Subsequently, a team of nine neurosurgeons from the Department of Neurosurgery at Leipzig University Hospital performed a standardized craniotomy on this phantom and evaluated the material in terms of its realism. Methods Selection Criteria for the Material Review A systematic literature search was conducted using the PubMed database to identify the materials used in the fabrication of skull phantoms for neurosurgical applications. The search encompassed entries listed between 2010 and 2025 (as of May 26, 2025). The following search terms were used: "3D printed skull neurosurgery," "3D printed skull phantom," "3D printed skull phantom in neurosurgery," "3D printed skull simulator," "3D printed skull simulator in neurosurgery," "three dimensional printed skull neurosurgery," "three dimensional printed skull phantom," "three dimensional printed skull phantom in neurosurgery," "three dimensional printed skull simulator," and "three dimensional printed skull simulator in neurosurgery." This preliminary investigation yielded a total of 1,741 publications. In preparation for further analysis, all duplicates and publications not available in English were excluded. Furthermore, articles that were not freely accessible were removed from consideration. The remaining studies were subjected to a more thorough review, and additional exclusion criteria were implemented. Specifically, articles were excluded if they involved the replication of animal skulls (e.g., rat or canine models), described only the maxilla or mandible, failed to report specific materials or did not clearly associate the materials with cranial replication, presented schematic or idealized representations of the skull, focused solely on the creation of 3D printed surgical guides, or addressed skull models used exclusively for cranioplasty fabrication. The latter group was excluded because the material properties in such cases were irrelevant, as only the anatomical form of the skull was of interest. 3D printed simulation model of the posterior cranial fossa A preliminary evaluation of various materials was conducted to inform the subsequent practical assessment. This evaluation was facilitated with the assistance of a neurosurgeon. Preliminary findings from this study informed the subsequent execution of a multi-participant study, which utilized a self-designed phantom. A phantom design, which had been meticulously planned in advance, was utilized for this purpose. The final phantom comprised the following components, as illustrated in Fig. 1 : a housing that incorporated a support structure for the cerebellum (gray), two interchangeable modules (blue), clamping brackets (yellow), and a schematic representation of the cerebellum (red). The modules depicted in blue in the figure delineate the region in which the craniotomy was to be performed in order to evaluate the material. These modules replicate the contour and thickness of the human skull, rendering them well suited for testing purposes. Material selection for the phantom A drilling study was conducted to preselect a suitable material for the phantom, particularly for the interchangeable modules. This drilling study utilized a methodology similar to that described by Dissanayaka, Maclachlan, et al. [ 8 ]. The initial selection of candidate materials was based on the elastic modulus of cortical bone, which is reported to range from 6 to 30 GPa [ 9 , 10 ]. In addition to matching the elastic modulus, the material under consideration had to be compatible with the 3D printing technologies available to us. The applicable printing methods, along with compatible materials and their respective elastic moduli, are summarized in Table 1 . Table 1 Material selection based on the existing printing processes Printing method Material Producer E-modulus in GPa Inverted vat polymerization (SLA) Tough 1500 Formlabs (Somerville, USA) 1,50 [ 11 ] White V4 2,80 [ 12 ] Biomed White 2,02 [ 13 ] Material extrusion (FDM) PLA Polymaker (Changshu, China) 1,99 [ 14 ] PA BASF (Ludwigshafen am Rhein, Germany) 2,42 [ 15 ] Powder bed fusion PA 12 HP (Paolo Alto, USA) 1,70 [ 16 ] The available materials exhibited lower elastic moduli than those typically reported in the literature for cortical bone. Nevertheless, test blocks with dimensions of 50 × 30 × 10 mm were printed from each of the materials listed in the table. Test blocks were fabricated from filament materials and printed with an infill density of 30%. The test drilling was performed using a surgical craniotome. The haptic evaluation of the materials was carried out and verified by a neurosurgeon (F.A.) at Leipzig University Hospital. Figure 2 presents the test blocks subsequent to drilling. It was determined that the materials PA (e) from BASF (Ludwigshafen am Rhein, Germany) and PA 12 (f) from HP (Paolo Alto, USA) exhibited a hardness that was significantly higher than the desired level. Upon contact with the craniotome, the surface melted, thereby preventing proper engagement. PLA (d) from Polymaker (Changshu, China) and Tough 1500 (c) from Formlabs (Somerville, USA) were also found to be unsuitable due to their excessive softness. The materials White V4 (b) and Biomed White (a) from Formlabs were both found to be highly realistic and accurate in terms of haptic feedback. Given its higher Young's modulus, White V4 was ultimately selected for use in the craniotomies. For the remaining portions of the phantom, PA 12 and PLA were employed. Manufacturing of the phantom The fabrication of the phantom was accomplished through the application of all previously mentioned techniques. The interchangeable modules on the sides were manufactured using the inverted vat polymerization method, specifically stereolithography (SLA). As previously stated, the material selected for this application was White V4 from Formlabs (Somerville, USA) . The printer utilized was the Form 3BL , also manufactured by the same company. The clamping brackets were produced using the material extrusion method, specifically fused deposition modeling (FDM), with the UltiMaker S7 printer from UltiMaker (Utrecht, Netherlands) . PLA from Polymaker (Changshu, China) was selected as the material for the brackets. The remaining components of the phantom, the housing, was created using the powder bed fusion method with a Multi Jet Fusion ( MJF 5200 ) printer from HP (Palo Alto, USA) . As previously stated, the material utilized for this component was PA 12 . The fabrication of the cerebellum was excluded from the description, as it had no impact on the material testing and was created solely for visual purposes. Table 2 Presentation of the manufacturing method and the materials used for each component of the phantom Manufacturing method Component/ object Printer Material Inverted vat polymerization (SLA) Interchangeable modules (both sides) Form 3BL (Formlabs - Somerville, USA) White V4 (Formlabs - Somerville, USA) Material extrusion (FDM) Clamping brackets UltiMaker S7 (UltiMaker - Utrecht, Netherlands) PLA (Polymaker - Changshu, China) Powder bed fusion Housing MJF 5200 (HP - Paolo Alto, USA) PA 12 (HP - Paolo Alto, USA) Mounting of the cerebellum Mold for the cerebellum Table 2 provides an overview of the individual components, the manufacturing methods employed, and the materials utilized. In the final stage of the manufacturing process, magnets were affixed to the corresponding cavities through the use of an adhesive, while threaded inserts were soldered into position. To ensure optimal storage and facilitate positioning adjustments, the phantom was affixed to a camera mount (MH494) from Manfrotto (Cassola, Italy) , which was then secured to a metal plate. The Fig. 3 depicts the completed three-dimensional (3D) printed simulation model for the posterior cranial fossa. Results Material Review Based on the defined selection criteria, a total of 68 publications from the years 2015 to 2025 were identified that described both the fabrication of a skull phantom and the materials used. The phantoms described in these studies were developed for various purposes. Therefore, the publications were first categorized into six distinct groups according to the application of the respective simulator. The groups are defined as follows: Phantoms for the evaluation of new therapeutic methods and their accuracy [ 17 – 26 ] Phantoms for surgical planning [ 27 – 38 ] Phantoms for education and hands-on training [ 39 – 60 ] Phantoms for imaging, calibration, and dosimetry purposes [ 61 – 64 ] Phantoms for testing and validation of new surgical tools [ 65 – 68 ] Phantoms for the simulation and visualization of pathological conditions [ 8 , 69 – 83 ] The individual groups, along with the distribution of the 68 publications among them, are visualized in Fig. 4 . The results indicate that approximately one-third of the identified publications employed phantoms for educational purposes or training in specific surgical procedures. Subsequent to this, applications pertaining to the visualization of pathological conditions, accounting for nearly one-fifth of the studies. The following materials (Fig. 5 ) were utilized in the creation of the various simulation models, irrespective of the application areas. The data presented in the figure indicates that approximately half of all fabricated skull phantoms were produced using PLA. Subsequently, the ABS and various resins from Formlabs (White, Grey, and Clear) are utilized. A comprehensive overview of all materials and their corresponding printing technologies is provided in Table 3 . Table 3 List of the materials used in the publications and their printing processes ([ 17 ] was excluded - no specific information about the material (plaster powder) available) Material Printing method PLA PLA [8, 18–22, 27–30, 39–47, 61–66, 69–75] material extrusion ABS ABS [23, 24, 31–33, 48, 49, 76] material extrusion Formlabs-Resin White Resin [25, 34, 50] inverted vat polymerization Grey Resin [35, 77] Clear Resin [36, 78] Plaster Powder ZP 150 Powder [26, 51, 79, 80] binder jetting ZP 130 Powder [52] PolyJet Material Med610 Resin [37] material Jetting Vero White [53–55, 81] PA12 basiert Duraform PA [67] powder bed fusion PA12 [56] Polyamid nylon with glass beads [57] PA2200 [82] VisiJet Material VisiJet PXL core [38, 83] material jetting VisiJet C4 Spectrum [58] Others PET-G [59] metarial extrusion PVC [68] N.A. Eleegoo photopolymer resin [60] inverted vat polymerization In Fig. 6 , the various materials are presented in relation to the previously defined application categories, allowing for the identification of potential trends. The data reveal that PLA is utilized across all categories. Furthermore, it is evident that the greatest variability in material choice is found within the domains of visualization and educational training. Practical Testing on the Phantom A survey was conducted among nine neurosurgeons at the Department of Neurosurgery, University Hospital Leipzig, with the objective of evaluating the visual and haptic properties of the model. The assessment was conducted employing a Likert scale ranging from 0 to 10 (0 = does not apply at all, poorly represented; 10 = fully applies, highly realistic). The evaluation process entailed two craniotomies and the milling of a predefined area, simulating a retrosigmoid approach for the treatment of an acoustic neuroma. The results are presented in Fig. 7 . Overall, the material was rated as realistic, with a mean score of 7.2. One participant noted that the material appeared slightly too rigid and criticized the absence of an internal porous structure (spongiosa). Discussion A comprehensive review of the extant literature reveals a broad array of materials and printing technologies that have been employed. To provide a more comprehensive contextual analysis, Fig. 8 presents a graphical representation of the distribution of the various manufacturing methods. Given the prevalence of PLA and ABS, material extrusion—particularly the Fused Deposition Modeling (FDM) process—emerges as the prevailing printing technique, accounting for approximately 60% of the cases. The phenomenon under discussion can be attributed to several factors. Firstly, the financial burden of materials and printers is relatively minimal. Secondly, there is a wide availability of suppliers and compatible materials. Thirdly, FDM devices are comparatively simple to operate and handle. Furthermore, FDM has become one of the most widely used additive manufacturing techniques around the world. The second most prevalent printing technologies are inverted vat polymerization and material jetting. These methods find application in resins from companies such as Formlabs, as well as in PolyJet and VisiJet materials. Despite the higher cost of these processes compared to FDM, they provide distinct advantages in terms of resolution and surface quality, enabling the fabrication of more intricate models. Additionally, material jetting enables the fabrication of multicolored models in a single print, a feature that is particularly advantageous for educational and demonstrative applications. Binder jetting and powder bed fusion—particularly the Selective Laser Sintering (SLS) process—are utilized with reduced frequency for the fabrication of neurosurgical skull phantoms. This occurrence can be attributed to the significant financial investments necessary for acquiring the essential equipment and materials, as well as the limited availability of suitable materials. Additionally, the post-processing, maintenance, and cleaning requirements for these devices are relatively intensive, rendering them less suitable for the production of individual models. A comparison of the application domains (Fig. 6 ) with the materials employed reveals no direct correlation. A notable example is the field of education and hands-on training, where surgical procedures are simulated, exhibiting significant variability in the materials utilized. This variation can be attributed to several factors, such as cost, the availability of specific printers, and material accessibility. However, a paucity of publications has been observed in the extant literature regarding the evaluation of material properties during drilling or milling. This may be attributable to the fact that the skull replicas were principally designed for visual purposes or that manipulation with surgical instruments was not necessary. Consequently, a meticulous study was undertaken to assess the material that received the highest ratings during the preliminary selection process. The material was evaluated by an experienced neurosurgeon (White V4 by Formlabs) through a hands-on testing process conducted by multiple neurosurgeons. The material was generally well-received. Among the nine participants, two perceived the substance as moderately hard, with one specifically noting the absence of an internal porous structure (spongiosa). In contrast, three participants regarded it as somewhat too soft. The divergent evaluations can be attributed to a number of factors. One potential explanation for this observation is the anatomical location of the defined surgical access. The test entailed a retrosigmoid approach, which intersects with the mastoid bone by approximately one-third. This region of the cranium is characterized by substantial thickness, which complicates excision. In the present configuration, the drilling point was situated within this region, necessitating increased exertion and potentially impacting the subjective perception of drilling resistance. Another potential factor in the variability of responses is the wear of the craniotome used. It is important to note that a single craniotome, and thus a single cutting tool, was available for the entirety of the testing period. Consequently, it is plausible that the tool experienced wear over time, leading to subsequent participants perceiving the material as harder. Finally, and perhaps most significantly, individual subjective experience plays a critical role in interpreting the results. For instance, the influence of prior surgical interventions on the participant's evaluation is a potential confounding factor. In the event that a surgeon has recently performed surgery on a patient with particularly soft bone, a consequence of advanced age or other underlying conditions, the surgeon may assess the material as overly hard, or vice versa. Conclusion The utilization of three-dimensional printing in the fabrication of medical phantoms and simulation models has undergone a substantial increase over the past 15 years. This trend can be attributed to three factors. First, there has been a growing diversity of 3D printing technologies. Second, there has been an expansion of the range of materials. Third, there has been improved accessibility. In the design of such models, the creation of anatomically realistic visual and haptic representations is of paramount importance. To this end, a comprehensive literature review of PubMed-listed articles on 3D printed skull models was conducted to gain an overview of the materials used. A total of 68 publications were identified. The analysis revealed that nearly 50% of the skull models described in the articles—regardless of their intended use—were made from PLA. This was followed by ABS at approximately 13% and resins from the company Formlabs at 10%. The prevalence of PLA can be attributed to its compatibility with a straightforward and widely accessible printing process, as well as its comparatively low cost. However, it should be noted that PLA does possess the drawback of not always providing sufficient mechanical strength to realistically replicate cranial bone. To identify a suitable material for the skull phantom, test drilling was performed using a craniotome on various materials and printing methods that were available. Subsequent to the analysis of the results, a phantom was fabricated using the material that demonstrated the most promising results. The bone replica was subsequently evaluated by nine neurosurgeons at the University Hospital Leipzig. The evaluation utilized a custom-developed Likert scale to assess the strength and realism of the replica. The final phantom was produced using White V4 resin from Formlabs. The material in the study was evaluated as relatively realistic, receiving a rating of 7.2. However, a certain degree of variation in assessments was observed. Two participants perceived the material to be too hard in comparison to real bone, while three others found it to be too soft. This variability may be attributed, for example, to the wear of the cutting instrument used. Additionally, the evaluation process was inherently subjective and may have been influenced by prior surgical interventions or individual experiences. In summary, a range of materials can be utilized in the fabrication of skull models. The selection is influenced by several factors, including cost, compatible printing technologies, and intended application. The present study demonstrated that White V4 from Formlabs is a suitable material for replicating drillable cranial bone. Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials The data are given in the paper and can be received on request. Competing interests The authors declare that they have no competing interests. Funding Open Access funding enabled and organized by Project DEAL. The study was carried out as part of project 16KN081071 under the ZIM funding program of the German Federal Ministry for Economic Affairs and Climate Protection. Authors’ contributions Author Svenja Jung wrote the main manuscript and is responsible for the research and the 3D printing. Svenja Jung is also co-responsible for the design process of the simulation model. Maike Stummer is responsible for the construction of the simulation model and co-responsible for the design process. Dirk Winkler, Erdem Güresir and Felix Arlt accompanied the clinical part of the study and provided their expertise in the medical background. Ronny Grunert and Felix Arlt prepared the methodology of the project. Acknowledgements Not applicable References Bai W, Fang H, Wang Y et al. (2021) Academic Insights and Perspectives in 3D Printing: A Bibliometric Review. Applied Sciences 11:8298. https://doi.org/10.3390/app11188298 Mommaerts MY, Depauw PR, Nout E (2020) Ceramic 3D-Printed Titanium Cranioplasty. Craniomaxillofac Trauma Reconstr 13:329–333. https://doi.org/10.1177/1943387520927916 Seraj FQM, Kheradmand D, Najafi S et al. (2025) Customized 3D-printed Poly ether ether ketone cranial implant for cranioplasty of skull defects. Neurosurg Rev 48:301. https://doi.org/10.1007/s10143-025-03448-7 Kropla F, Hoffmann M, Winkler D et al. (2023) Development of an individual helmet orthosis for infants based on a 3D scan. 3D Print Med 9:22. https://doi.org/10.1186/s41205-023-00187-7 Chen C-S, Chang Y-S, Lin K-W et al. (2024) Biomechanical evaluation of 3D-printed joint-type orthosis for hallux valgus. J Chin Med Assoc 87:809–814. https://doi.org/10.1097/JCMA.0000000000001120 Honigmann P, Sharma N, Schumacher R et al. (2021) In-Hospital 3D Printed Scaphoid Prosthesis Using Medical-Grade Polyetheretherketone (PEEK) Biomaterial. Biomed Res Int 2021:1301028. https://doi.org/10.1155/2021/1301028 Cui Y, Chen B, Wang G et al. (2023) Partial talar replacement with a novel 3D printed prosthesis. Comput Assist Surg (Abingdon) 28:2198106. https://doi.org/10.1080/24699322.2023.2198106 Dissanayaka N, Maclachlan LR, Alexander H et al. (2023) Evaluation of 3D Printed Burr Hole Simulation Models Using 8 Different Materials. World Neurosurg 176:e651-e663. https://doi.org/10.1016/j.wneu.2023.05.115 Zhang J, Tian W, Chen J et al. (2019) The application of polyetheretherketone (PEEK) implants in cranioplasty. Brain Res Bull 153:143–149. https://doi.org/10.1016/j.brainresbull.2019.08.010 Su Q, Qiao Y, Xiao Y et al. (2023) Research progress of 3D printed poly (ether ether ketone) in the reconstruction of craniomaxillofacial bone defects. Front Bioeng Biotechnol 11:1259696. https://doi.org/10.3389/fbioe.2023.1259696 Formlabs GmbH Tough 1500 Formlabs GmbH General Purpose Resins Formlabs GmbH BioMed White Polymaker PolyTerra TM PLA: Technical Data Sheet BASF SE Ultrafuse PA: Technical Data Sheet HP Development Company HP 3D High Reusability PA 12 Reinacher PC, Krüger MT, Coenen VA et al. (2017) Determining the Orientation of Directional Deep Brain Stimulation Electrodes Using 3D Rotational Fluoroscopy. AJNR Am J Neuroradiol 38:1111–1116. https://doi.org/10.3174/ajnr.A5153 Wan S, Rodrigues DB, Kwiatkowski J et al. (2023) Evaluation of a Balloon Implant for Simultaneous Magnetic Nanoparticle Hyperthermia and High-Dose-Rate Brachytherapy of Brain Tumor Resection Cavities. Cancers (Basel) 15. https://doi.org/10.3390/cancers15235683 Cao F, Gao Z, Qi S et al. (2023) Realistic three-layer head phantom for optically pumped magnetometer-based magnetoencephalography. Comput Biol Med 164:107318. https://doi.org/10.1016/j.compbiomed.2023.107318 Eom S, Ma TS, Vutakuri N et al. (2024) Accuracy of routine external ventricular drain placement following a mixed reality-guided twist-drill craniostomy. Neurosurg Focus 56:E11. https://doi.org/10.3171/2023.10.FOCUS23615 Mukwada G, Hirst A, Rowshanfarzad P et al. (2024) Development of a 3D printed phantom for commissioning and quality assurance of multiple brain targets stereotactic radiosurgery. Phys Eng Sci Med 47:455–463. https://doi.org/10.1007/s13246-023-01374-w van Doormaal JAM, Fick T, Boskovic E et al. (2025) Development and Validation of a Neurosurgical Phantom for Simulating External Ventricular Drain Placement. J Med Syst 49:1. https://doi.org/10.1007/s10916-024-02133-4 Menikou G, Dadakova T, Pavlina M et al. (2015) MRI compatible head phantom for ultrasound surgery. Ultrasonics 57:144–152. https://doi.org/10.1016/j.ultras.2014.11.004 Antoniou A, Damianou C (2024) Feasibility of Ultrasonic Heating through Skull Phantom Using Single-element Transducer. J Med Ultrasound 32:32–40. https://doi.org/10.4103/jmu.jmu_3_23 Civilla L, Dodier P, Palumbo MC et al. (2024) Development and assessment of case-specific physical and augmented reality simulators for intracranial aneurysm clipping. 3D Print Med 10:30. https://doi.org/10.1186/s41205-024-00235-w Li H, Chen RK, Tang Y et al. (2018) An experimental study and finite element modeling of head and neck cooling for brain hypothermia. J Therm Biol 71:99–111. https://doi.org/10.1016/j.jtherbio.2017.10.022 Mendez BM, Chiodo MV, Patel PA (2015) Customized "In-Office" Three-Dimensional Printing for Virtual Surgical Planning in Craniofacial Surgery. J Craniofac Surg 26:1584–1586. https://doi.org/10.1097/SCS.0000000000001768 Mackle EC, Shapey J, Maneas E et al. (2020) Patient-Specific Polyvinyl Alcohol Phantom Fabrication with Ultrasound and X-Ray Contrast for Brain Tumor Surgery Planning. J Vis Exp. https://doi.org/10.3791/61344 Uzunoglu I, Kızmazoglu C, Husemoglu RB et al. (2021) Three-Dimensional Printing Assisted Preoperative Surgical Planning for Cerebral Arteriovenous Malformation. J Korean Neurosurg Soc 64:882–890. https://doi.org/10.3340/jkns.2021.0016 Zahid F, Memon A, Siddiqui M et al. (2024) Successful use of a patient specific 3D-printed biomodel as surgical guide for excision of juvenile nasopharyngeal angiofibroma extending to skull base: A case report. Surg Neurol Int 15:44. https://doi.org/10.25259/SNI_743_2023 Huang X, Fan N, Wang H-J et al. (2021) Application of 3D printed model for planning the endoscopic endonasal transsphenoidal surgery. Sci Rep 11:5333. https://doi.org/10.1038/s41598-021-84779-5 Duan H, Jiang X, Li C et al. (2022) Application of a three-dimensional printed model to localize a cranial cerebrospinal fluid leak: a case report. J Int Med Res 50:3000605221078412. https://doi.org/10.1177/03000605221078412 Chen P-C, Yang Y-W, Lin J-C et al. (2022) Advanced Manufacturing in the Fabrication of a Lifelike Brain Glioblastoma Simulator for the Training of Neurosurgeons. Polymers (Basel) 14. https://doi.org/10.3390/polym14061072 Panesar SS, Magnetta M, Mukherjee D et al. (2019) Patient-specific 3-dimensionally printed models for neurosurgical planning and education. Neurosurg Focus 47:E12. https://doi.org/10.3171/2019.9.FOCUS19511 Grau S, Kellermann S, Faust M et al. (2018) Repair of Cerebrospinal Fluid Leakage Using a Transfrontal, Radial Adipofascial Flap: An Individual Approach Supported by Three-Dimensional Printing for Surgical Planning. World Neurosurg 110:315–318. https://doi.org/10.1016/j.wneu.2017.11.083 Marques MA, Purnell CA, Zhao L et al. (2023) Patient-specific Composite Anatomic Models: Improving the Foundation for Craniosynostosis Repair. J Craniofac Surg 34:1078–1081. https://doi.org/10.1097/SCS.0000000000009182 Langdon C, Hinojosa-Bernal J, Munuera J et al. (2023) 3D printing as surgical planning and training in pediatric endoscopic skull base surgery - Systematic review and practical example. Int J Pediatr Otorhinolaryngol 168:111543. https://doi.org/10.1016/j.ijporl.2023.111543 Eisenmenger LB, Wiggins RH, Fults DW et al. (2017) Application of 3-Dimensional Printing in a Case of Osteogenesis Imperfecta for Patient Education, Anatomic Understanding, Preoperative Planning, and Intraoperative Evaluation. World Neurosurg 107:1049.e1-1049.e7. https://doi.org/10.1016/j.wneu.2017.08.026 Bannon R, Parihar S, Skarparis Y et al. (2018) 3D printing the pterygopalatine fossa: a negative space model of a complex structure. Surg Radiol Anat 40:185–191. https://doi.org/10.1007/s00276-017-1916-x Garling RJ, Jin X, Yang J et al. (2018) Low-cost endoscopic third ventriculostomy simulator with mimetic endoscope. J Neurosurg Pediatr 22:137–146. https://doi.org/10.3171/2018.2.PEDS17671 Shen Z, Yao Y, Xie Y et al. (2019) The process of 3D printed skull models for anatomy education. Comput Assist Surg (Abingdon) 24:121–130. https://doi.org/10.1080/24699322.2018.1560101 Duda S, Meyer L, Musienko E et al. (2020) The Manufacturing of 3D Printed models for the Neurotraumatological Education of Military Surgeons. Mil Med 185:e2013-e2019. https://doi.org/10.1093/milmed/usaa183 Licci M, Thieringer FM, Guzman R et al. (2020) Development and validation of a synthetic 3D-printed simulator for training in neuroendoscopic ventricular lesion removal. Neurosurg Focus 48:E18. https://doi.org/10.3171/2019.12.FOCUS19841 Nebor I, Hussein AE, Montemagno K et al. (2022) Primary Dural Repair via an Endoscopic Endonasal Corridor: Preliminary Development of a 3D-Printed Model for Training. J Neurol Surg B Skull Base 83:e260-e265. https://doi.org/10.1055/s-0041-1725027 Byvaltsev V, Polkin R, Bereznyak D et al. (2021) 3D-printed cranial models simulating operative field depth for microvascular training in neurosurgery. Surg Neurol Int 12:213. https://doi.org/10.25259/SNI_849_2020 Entezami P, Spurgas MP, O'Brien MW et al. (2022) Utility of 3-dimensionally printed models for parent education in pediatric plagiocephaly. PEC Innov 1:100077. https://doi.org/10.1016/j.pecinn.2022.100077 Jeising S, Liu S, Blaszczyk T et al. (2024) Combined use of 3D printing and mixed reality technology for neurosurgical training: getting ready for brain surgery. Neurosurg Focus 56:E12. https://doi.org/10.3171/2023.10.FOCUS23611 Mooney MA, Cavallo C, Zhou JJ et al. (2020) Three-Dimensional Printed Models for Lateral Skull Base Surgical Training: Anatomy and Simulation of the Transtemporal Approaches. Oper Neurosurg (Hagerstown) 18:193–201. https://doi.org/10.1093/ons/opz120 Belykh E, Abramov I, Bardonova L et al. (2023) Seven bypasses simulation set: description and validity assessment of novel models for microneurosurgical training. J Neurosurg 138:732–739. https://doi.org/10.3171/2022.5.JNS22465 Freiser ME, Ghodadra A, Hirsch BE et al. (2019) Evaluation of 3D Printed Temporal Bone Models in Preparation for Middle Cranial Fossa Surgery. Otol Neurotol 40:246–253. https://doi.org/10.1097/MAO.0000000000002073 Kondo K, Nemoto M, Masuda H et al. (2015) Anatomical Reproducibility of a Head Model Molded by a Three-dimensional Printer. Neurol Med Chir (Tokyo) 55:592–598. https://doi.org/10.2176/nmc.oa.2014-0436 Mashiko T, Kaneko N, Konno T et al. (2017) Training in Cerebral Aneurysm Clipping Using Self-Made 3-Dimensional Models. J Surg Educ 74:681–689. https://doi.org/10.1016/j.jsurg.2016.12.010 Saleh Y, Piper R, Richard M et al. (2022) Designing a 3D Printed Model of the Skull-Base: A Collaboration Between Clinicians and Industry. J Med Educ Curric Dev 9:23821205221080703. https://doi.org/10.1177/23821205221080703 Watanabe N, Watanabe K, Fujimura S et al. (2023) Real Stiffness and Vividness Reproduction of Anatomic Structures Into the 3-Dimensional Printed Models Contributes to Improved Simulation and Training in Skull Base Surgery. Oper Neurosurg (Hagerstown) 24:548–555. https://doi.org/10.1227/ons.0000000000000583 Rahmani R, Santangelo G, Jalal MI et al. (2024) A Simple 3D Printed Model for Intracranial Vascular Anastomosis Practice and the Rochester Bypass Training Score. Oper Neurosurg (Hagerstown) 26:341–345. https://doi.org/10.1227/ons.0000000000000931 Scheidt K, Kropla F, Winkler D et al. (2025) 3D-printed skull model for enhancing training in external ventricular drainage within medical education. 3D Print Med 11:16. https://doi.org/10.1186/s41205-025-00263-0 Wanibuchi M, Noshiro S, Sugino T et al. (2016) Training for Skull Base Surgery with a Colored Temporal Bone Model Created by Three-Dimensional Printing Technology. World Neurosurg 91:66–72. https://doi.org/10.1016/j.wneu.2016.03.084 Eastwood KW, Bodani VP, Haji FA et al. (2018) Development of synthetic simulators for endoscope-assisted repair of metopic and sagittal craniosynostosis. J Neurosurg Pediatr 22:128–136. https://doi.org/10.3171/2018.2.PEDS18121 Chen J, Kumar S, Shallal C et al. (2022) Caregiver Preferences for Three-Dimensional Printed or Augmented Reality Craniosynostosis Skull Models: A Cross-Sectional Survey. J Craniofac Surg 33:151–155. https://doi.org/10.1097/SCS.0000000000008134 Piazza A, Corvino S, Colosso GQ et al. (2024) 3-Dimensional Printed Model of the Temporal Bone for Neurosurgical Training. Oper Neurosurg (Hagerstown) 27:749–755. https://doi.org/10.1227/ons.0000000000001213 Avery J, Aristovich K, Low B et al. (2017) Reproducible 3D printed head tanks for electrical impedance tomography with realistic shape and conductivity distribution. Physiol Meas 38:1116–1131. https://doi.org/10.1088/1361-6579/aa6586 Church C, Parsons D, Syme A (2022) Region-of-interest intra-arc MV imaging to facilitate sub-mm positional accuracy with minimal imaging dose during treatment deliveries of small cranial lesions. J Appl Clin Med Phys 23:e13769. https://doi.org/10.1002/acm2.13769 Lai M, Skyrman S, Kor F et al. (2022) Development of a CT-Compatible, Anthropomorphic Skull and Brain Phantom for Neurosurgical Planning, Training, and Simulation. Bioengineering (Basel) 9. https://doi.org/10.3390/bioengineering9100537 Endarko E, Pitaloka AW, Inayah AA et al. (2023) Evaluation of 3D Printed Anthropomorphic Head Phantom for Calibration of TLD in Eye Lens Dosimeter. J Biomed Phys Eng 13:193–202. https://doi.org/10.31661/jbpe.v0i0.2109-1401 Skyrman S, Lai M, Edström E et al. (2021) Augmented reality navigation for cranial biopsy and external ventricular drain insertion. Neurosurg Focus 51:E7. https://doi.org/10.3171/2021.5.FOCUS20813 Khan RI, McElhinney K, Dickson A et al. (2024) Image-guided orbital surgery: a preclinical validation study using a high-resolution physical model. BMJ Open Ophthalmol 9. https://doi.org/10.1136/bmjophth-2023-001568 Vakharia VN, Rodionov R, McEvoy AW et al. (2019) Improving patient safety during introduction of novel medical devices through cumulative summation analysis. J Neurosurg 130:213–219. https://doi.org/10.3171/2017.8.JNS17936 Cui M, Ren W, Cui T et al. (2024) Design of intelligent human-machine collaborative robot-assisted craniotomy system. Heliyon 10:e40364. https://doi.org/10.1016/j.heliyon.2024.e40364 Naftulin JS, Kimchi EY, Cash SS (2015) Streamlined, Inexpensive 3D Printing of the Brain and Skull. PLoS One 10:e0136198. https://doi.org/10.1371/journal.pone.0136198 Gadaleta DJ, Huang D, Rankin N et al. (2020) 3D printed temporal bone as a tool for otologic surgery simulation. Am J Otolaryngol 41:102273. https://doi.org/10.1016/j.amjoto.2019.08.004 Shen Z, Xie Y, Shang X et al. (2020) The manufacturing procedure of 3D printed models for endoscopic endonasal transsphenoidal pituitary surgery. Technol Health Care 28:131–150. https://doi.org/10.3233/THC-209014 Nebor I, Anderson Z, Mejia-Munne JC et al. (2022) 2D versus 3D Endoscopy: Head-to-Head Comparison in a Simulated Model of Endoscopic Endonasal Dural Suturing. J Neurol Surg B Skull Base 83:423–429. https://doi.org/10.1055/s-0041-1736635 Mian SY, Jayasangaran S, Qureshi A et al. (2023) Exploring the Impact of Using Patient-Specific 3D Prints during Consent for Skull Base Neurosurgery. J Neurol Surg B Skull Base 84:463–469. https://doi.org/10.1055/a-1885-1111 Sidabutar R, Yudha TW, Sutiono AB et al. (2023) Low-cost and open-source three-dimensional (3D) printing in neurosurgery: A pilot experiment using direct drive modification to produce multi-material neuroanatomical models. Clin Neurol Neurosurg 228:107684. https://doi.org/10.1016/j.clineuro.2023.107684 Krivankova B, Burns M, Gasser I et al. (2024) Repair of lateral temporo-sphenoidal encephalocoele via an endoscopic transorbital approach: ex vivo 3D printed simulation followed by in vivo deployment. Br J Neurosurg:1–6. https://doi.org/10.1080/02688697.2023.2297878 Lee MH, Lee T-K (2022) Cadaver-Free Neurosurgical Simulation Using a 3-Dimensional Printer and Augmented Reality. Oper Neurosurg (Hagerstown) 23:46–52. https://doi.org/10.1227/ons.0000000000000184 Chae R, Sharon JD, Kournoutas I et al. (2020) Replicating Skull Base Anatomy With 3D Technologies: A Comparative Study Using 3D-scanned and 3D-printed Models of the Temporal Bone. Otol Neurotol 41:e392-e403. https://doi.org/10.1097/MAO.0000000000002524 Jimenez JE, Shaffer AD, Hammersley E et al. (2023) Use of patient-specific 3D printed models in pre-operative counseling for pediatric skull base surgery. Int J Pediatr Otorhinolaryngol 171:111655. https://doi.org/10.1016/j.ijporl.2023.111655 Nagassa RG, McMenamin PG, Adams JW et al. (2019) Advanced 3D printed model of middle cerebral artery aneurysms for neurosurgery simulation. 3D Print Med 5:11. https://doi.org/10.1186/s41205-019-0048-9 Kondo K, Nemoto M, Harada N et al. (2019) Three-Dimensional Printed Model for Surgical Simulation of Combined Transpetrosal Approach. World Neurosurg 127:e609-e616. https://doi.org/10.1016/j.wneu.2019.03.219 Hsieh T-Y, Cervenka B, Dedhia R et al. (2018) Assessment of a Patient-Specific, 3-Dimensionally Printed Endoscopic Sinus and Skull Base Surgical Model. JAMA Otolaryngol Head Neck Surg 144:574–579. https://doi.org/10.1001/jamaoto.2018.0473 Ghizoni E, Souza JPSAS de, Raposo-Amaral CE et al. (2018) 3D-Printed Craniosynostosis Model: New Simulation Surgical Tool. World Neurosurg 109:356–361. https://doi.org/10.1016/j.wneu.2017.10.025 London NR, Rangel GG, VanKoevering K et al. (2021) Simulation of Pediatric Anterior Skull Base Anatomy Using a 3D Printed Model. World Neurosurg 147:e405-e410. https://doi.org/10.1016/j.wneu.2020.12.077 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 10 Sep, 2025 Reviewers agreed at journal 09 Sep, 2025 Reviewers invited by journal 01 Sep, 2025 Editor assigned by journal 29 Jun, 2025 Submission checks completed at journal 29 Jun, 2025 First submitted to journal 27 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6991325","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Method Article","associatedPublications":[],"authors":[{"id":508287450,"identity":"3eaaf176-7bd5-4330-9d1c-15c935804bf7","order_by":0,"name":"Svenja Jung","email":"data:image/png;base64,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","orcid":"","institution":"University of Leipzig Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Svenja","middleName":"","lastName":"Jung","suffix":""},{"id":508287452,"identity":"2b662461-cb3f-4f6f-b07e-2fb781160cd9","order_by":1,"name":"Maike Stummer","email":"","orcid":"","institution":"University of Leipzig Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Maike","middleName":"","lastName":"Stummer","suffix":""},{"id":508287454,"identity":"272ff739-5f52-484a-88b2-b12f9518eacd","order_by":2,"name":"Erdem Güresir","email":"","orcid":"","institution":"University of Leipzig Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Erdem","middleName":"","lastName":"Güresir","suffix":""},{"id":508287456,"identity":"f437eef2-a029-41fc-8f71-1e102a6ef871","order_by":3,"name":"Dirk Winkler","email":"","orcid":"","institution":"University of Leipzig Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Dirk","middleName":"","lastName":"Winkler","suffix":""},{"id":508287457,"identity":"a52aba78-f45e-49d8-9f9e-147c5d69b53b","order_by":4,"name":"Ronny Grunert","email":"","orcid":"","institution":"University of Leipzig Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Ronny","middleName":"","lastName":"Grunert","suffix":""},{"id":508287458,"identity":"53a01bd8-3ab5-41dc-ab95-616819c45a48","order_by":5,"name":"Felix Arlt","email":"","orcid":"","institution":"University of Leipzig Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Felix","middleName":"","lastName":"Arlt","suffix":""}],"badges":[],"createdAt":"2025-06-27 11:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6991325/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6991325/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90887076,"identity":"bf207aac-4ab8-4f34-97b1-ccddb28b1b74","added_by":"auto","created_at":"2025-09-09 10:19:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":965746,"visible":true,"origin":"","legend":"\u003cp\u003eExplosion drawing of the entire phantom including the cerebellum\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6991325/v1/bf2174a4ed8c19481ad56b34.png"},{"id":90885157,"identity":"307615b3-b5c5-4170-afca-96d6d1f655b3","added_by":"auto","created_at":"2025-09-09 10:03:03","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":475804,"visible":true,"origin":"","legend":"\u003cp\u003eTest blocks after the drilling process - a) Biomed White (Formlabs), b) White V4 (Formlabs),\u003c/p\u003e\n\u003cp\u003ec) Tough1500 (Formlabs), d) PLA (PolyMaker), e) PA (BASF) and f) PA12 (HP)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6991325/v1/bffa87b9fbf7cb624aa96db5.png"},{"id":90883699,"identity":"787f487b-0da1-4429-96a7-adc6bdc146ac","added_by":"auto","created_at":"2025-09-09 09:55:03","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":609796,"visible":true,"origin":"","legend":"\u003cp\u003eFinished skull phantom with a look at the interchangeable modules (left) and the representation of all removable elements (right)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6991325/v1/5336ef7f922f820cb182f27b.png"},{"id":90883696,"identity":"a9d2056a-b307-4579-902c-95a2a1564440","added_by":"auto","created_at":"2025-09-09 09:55:03","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":184439,"visible":true,"origin":"","legend":"\u003cp\u003ePresentation of the distribution of the 68 publications across the various groups\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6991325/v1/16e9ada5c5e4926fd626e28c.png"},{"id":90885158,"identity":"5dd6f8c6-33e4-4849-9211-13f060fcba23","added_by":"auto","created_at":"2025-09-09 10:03:03","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":139984,"visible":true,"origin":"","legend":"\u003cp\u003ePresentation of the materials used in the 68 publications, including the relative distribution\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6991325/v1/b54b896680950cf14b061537.png"},{"id":90885162,"identity":"bc5e8474-5e5a-4758-b304-4f48ffb19381","added_by":"auto","created_at":"2025-09-09 10:03:03","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":149415,"visible":true,"origin":"","legend":"\u003cp\u003eAllocation of the materials used in the publications to the various application areas\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-6991325/v1/1eff551bb6793b68b958ec19.png"},{"id":90883692,"identity":"2974c5e1-e29f-4400-922a-e9f08c9bb807","added_by":"auto","created_at":"2025-09-09 09:55:03","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":60571,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant's evaluation of the material (White V4, Formlabs) using the Likert scale\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-6991325/v1/8239f7a0e021db0ab78cc0ba.png"},{"id":90883715,"identity":"23e99ed3-47a4-42de-b7b4-80b61f476034","added_by":"auto","created_at":"2025-09-09 09:55:04","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":152339,"visible":true,"origin":"","legend":"\u003cp\u003eRelative distribution of the different printing processes used in the various publications\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-6991325/v1/cdc0ec13ae141df30a08d691.png"},{"id":90888311,"identity":"2f6f0445-3f9a-4265-a634-f7cd1fa7f1a7","added_by":"auto","created_at":"2025-09-09 10:27:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4549709,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6991325/v1/548dff7b-378b-4cb9-b24d-318772de1f70.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Suitable materials for the creation of neurosurgical phantoms using the example of a 3D printed simulation model of the posterior fossa","fulltext":[{"header":"Background","content":"\u003cp\u003eIn the past 15 years, there has been an exponential increase in the number of publications focusing on the topic of 3D printing [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This development spans a wide range of sectors, including architecture, the automotive and toy industries, as well as biology and medicine. The field of medicine offers a vast spectrum of applications, including implants [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], orthoses [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and prostheses [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Another significant domain of application pertains to phantoms or simulation models, which can be utilized, for instance, to represent various anatomical structures or to evaluate novel therapeutic approaches and surgical instruments. In this context, it is imperative to reproduce the relevant anatomical region as realistically as possible to ensure the validity and clinical relevance of such tests. Consequently, the identification of 3D printable materials capable of accurately replicating specific anatomical structures is of particular interest. This would facilitate the development of simplified yet realistic models of organs such as the liver, brain, or bone. Given our proximity to the field of neurosurgery, the replication of the brain and skull is of significant importance. This is particularly salient in the case of the skull, which is opened in virtually all neurosurgical procedures. It is imperative that this structure be replicated with the utmost fidelity when designing a simulation model. This ensures that the training scenario closely resembles actual surgical conditions.\u003c/p\u003e\u003cp\u003eThe objective of this study was twofold: first, to conduct a comprehensive literature review of skull models produced via 3D printing over the past 15 years, with a particular focus on the materials used. In light of the findings from this review, and in consideration of the 3D printers and materials at our disposal, we initiated an experimental study. In the preliminary phase, a series of materials were evaluated through simulated craniotomies to ascertain which material most closely replicates the mechanical properties of authentic bone. In the subsequent phase, a phantom was fabricated using the most suitable material. Subsequently, a team of nine neurosurgeons from the Department of Neurosurgery at Leipzig University Hospital performed a standardized craniotomy on this phantom and evaluated the material in terms of its realism.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSelection Criteria for the Material Review\u003c/h2\u003e\u003cp\u003eA systematic literature search was conducted using the PubMed database to identify the materials used in the fabrication of skull phantoms for neurosurgical applications. The search encompassed entries listed between 2010 and 2025 (as of May 26, 2025). The following search terms were used: \"3D printed skull neurosurgery,\" \"3D printed skull phantom,\" \"3D printed skull phantom in neurosurgery,\" \"3D printed skull simulator,\" \"3D printed skull simulator in neurosurgery,\" \"three dimensional printed skull neurosurgery,\" \"three dimensional printed skull phantom,\" \"three dimensional printed skull phantom in neurosurgery,\" \"three dimensional printed skull simulator,\" and \"three dimensional printed skull simulator in neurosurgery.\" This preliminary investigation yielded a total of 1,741 publications. In preparation for further analysis, all duplicates and publications not available in English were excluded. Furthermore, articles that were not freely accessible were removed from consideration. The remaining studies were subjected to a more thorough review, and additional exclusion criteria were implemented. Specifically, articles were excluded if they involved the replication of animal skulls (e.g., rat or canine models), described only the maxilla or mandible, failed to report specific materials or did not clearly associate the materials with cranial replication, presented schematic or idealized representations of the skull, focused solely on the creation of 3D printed surgical guides, or addressed skull models used exclusively for cranioplasty fabrication. The latter group was excluded because the material properties in such cases were irrelevant, as only the anatomical form of the skull was of interest.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003e3D printed simulation model of the posterior cranial fossa\u003c/h3\u003e\n\u003cp\u003eA preliminary evaluation of various materials was conducted to inform the subsequent practical assessment. This evaluation was facilitated with the assistance of a neurosurgeon. Preliminary findings from this study informed the subsequent execution of a multi-participant study, which utilized a self-designed phantom. A phantom design, which had been meticulously planned in advance, was utilized for this purpose. The final phantom comprised the following components, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: a housing that incorporated a support structure for the cerebellum (gray), two interchangeable modules (blue), clamping brackets (yellow), and a schematic representation of the cerebellum (red).\u003c/p\u003e\u003cp\u003eThe modules depicted in blue in the figure delineate the region in which the craniotomy was to be performed in order to evaluate the material. These modules replicate the contour and thickness of the human skull, rendering them well suited for testing purposes.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eMaterial selection for the phantom\u003c/h3\u003e\n\u003cp\u003eA drilling study was conducted to preselect a suitable material for the phantom, particularly for the interchangeable modules. This drilling study utilized a methodology similar to that described by Dissanayaka, Maclachlan, et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The initial selection of candidate materials was based on the elastic modulus of cortical bone, which is reported to range from 6 to 30 GPa [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In addition to matching the elastic modulus, the material under consideration had to be compatible with the 3D printing technologies available to us. The applicable printing methods, along with compatible materials and their respective elastic moduli, are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaterial selection based on the existing printing processes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrinting method\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaterial\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProducer\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eE-modulus in GPa\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eInverted vat polymerization (SLA)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTough 1500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eFormlabs\u003c/p\u003e\u003cp\u003e(Somerville, USA)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,50 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhite V4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2,80 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBiomed White\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2,02 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMaterial extrusion (FDM)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePLA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePolymaker\u003c/p\u003e\u003cp\u003e(Changshu, China)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,99 [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBASF\u003c/p\u003e\u003cp\u003e(Ludwigshafen am Rhein, Germany)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2,42 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePowder bed fusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePA\u0026nbsp;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHP\u003c/p\u003e\u003cp\u003e(Paolo Alto, USA)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,70 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe available materials exhibited lower elastic moduli than those typically reported in the literature for cortical bone. Nevertheless, test blocks with dimensions of 50 \u0026times; 30 \u0026times; 10 mm were printed from each of the materials listed in the table. Test blocks were fabricated from filament materials and printed with an infill density of 30%. The test drilling was performed using a surgical craniotome. The haptic evaluation of the materials was carried out and verified by a neurosurgeon (F.A.) at Leipzig University Hospital. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the test blocks subsequent to drilling.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIt was determined that the materials \u003cem\u003ePA\u003c/em\u003e (e) from \u003cem\u003eBASF (Ludwigshafen am Rhein, Germany)\u003c/em\u003e and \u003cem\u003ePA 12\u003c/em\u003e (f) from \u003cem\u003eHP (Paolo Alto, USA)\u003c/em\u003e exhibited a hardness that was significantly higher than the desired level. Upon contact with the craniotome, the surface melted, thereby preventing proper engagement. \u003cem\u003ePLA\u003c/em\u003e (d) from \u003cem\u003ePolymaker (Changshu, China)\u003c/em\u003e and \u003cem\u003eTough 1500\u003c/em\u003e (c) from \u003cem\u003eFormlabs (Somerville, USA)\u003c/em\u003e were also found to be unsuitable due to their excessive softness. The materials \u003cem\u003eWhite V4\u003c/em\u003e (b) and \u003cem\u003eBiomed White\u003c/em\u003e (a) from \u003cem\u003eFormlabs\u003c/em\u003e were both found to be highly realistic and accurate in terms of haptic feedback. Given its higher Young's modulus, White V4 was ultimately selected for use in the craniotomies. For the remaining portions of the phantom, PA 12 and PLA were employed.\u003c/p\u003e\n\u003ch3\u003eManufacturing of the phantom\u003c/h3\u003e\n\u003cp\u003eThe fabrication of the phantom was accomplished through the application of all previously mentioned techniques. The interchangeable modules on the sides were manufactured using the inverted vat polymerization method, specifically stereolithography (SLA). As previously stated, the material selected for this application was \u003cem\u003eWhite V4\u003c/em\u003e from \u003cem\u003eFormlabs (Somerville, USA)\u003c/em\u003e. The printer utilized was the \u003cem\u003eForm 3BL\u003c/em\u003e, also manufactured by the same company. The clamping brackets were produced using the material extrusion method, specifically fused deposition modeling (FDM), with the \u003cem\u003eUltiMaker S7\u003c/em\u003e printer from \u003cem\u003eUltiMaker (Utrecht, Netherlands)\u003c/em\u003e. \u003cem\u003ePLA\u003c/em\u003e from \u003cem\u003ePolymaker (Changshu, China)\u003c/em\u003e was selected as the material for the brackets. The remaining components of the phantom, the housing, was created using the powder bed fusion method with a Multi Jet Fusion (\u003cem\u003eMJF 5200\u003c/em\u003e) printer from \u003cem\u003eHP (Palo Alto, USA)\u003c/em\u003e. As previously stated, the material utilized for this component was \u003cem\u003ePA 12\u003c/em\u003e. The fabrication of the cerebellum was excluded from the description, as it had no impact on the material testing and was created solely for visual purposes.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePresentation of the manufacturing method and the materials used for each component of the phantom\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManufacturing\u003c/p\u003e\u003cp\u003emethod\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eComponent/ object\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePrinter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMaterial\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInverted vat polymerization (SLA)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterchangeable modules (both sides)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eForm 3BL\u003c/p\u003e\u003cp\u003e(Formlabs - Somerville, USA)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWhite V4\u003c/p\u003e\u003cp\u003e(Formlabs - Somerville, USA)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaterial extrusion (FDM)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClamping brackets\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUltiMaker S7\u003c/p\u003e\u003cp\u003e(UltiMaker - Utrecht, Netherlands)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePLA\u003c/p\u003e\u003cp\u003e(Polymaker - Changshu, China)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePowder bed fusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHousing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eMJF\u0026nbsp;5200\u003c/p\u003e\u003cp\u003e(HP - Paolo Alto, USA)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePA\u0026nbsp;12\u003c/p\u003e\u003cp\u003e(HP - Paolo Alto, USA)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMounting of the cerebellum\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMold for the cerebellum\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e provides an overview of the individual components, the manufacturing methods employed, and the materials utilized. In the final stage of the manufacturing process, magnets were affixed to the corresponding cavities through the use of an adhesive, while threaded inserts were soldered into position. To ensure optimal storage and facilitate positioning adjustments, the phantom was affixed to a camera mount \u003cem\u003e(MH494)\u003c/em\u003e from \u003cem\u003eManfrotto (Cassola, Italy)\u003c/em\u003e, which was then secured to a metal plate. The Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e depicts the completed three-dimensional (3D) printed simulation model for the posterior cranial fossa.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eMaterial Review\u003c/h2\u003e\u003cp\u003eBased on the defined selection criteria, a total of 68 publications from the years 2015 to 2025 were identified that described both the fabrication of a skull phantom and the materials used. The phantoms described in these studies were developed for various purposes. Therefore, the publications were first categorized into six distinct groups according to the application of the respective simulator. The groups are defined as follows:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ePhantoms for the evaluation of new therapeutic methods and their accuracy [\u003cspan additionalcitationids=\"CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePhantoms for surgical planning [\u003cspan additionalcitationids=\"CR28 CR29 CR30 CR31 CR32 CR33 CR34 CR35 CR36 CR37\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePhantoms for education and hands-on training [\u003cspan additionalcitationids=\"CR40 CR41 CR42 CR43 CR44 CR45 CR46 CR47 CR48 CR49 CR50 CR51 CR52 CR53 CR54 CR55 CR56 CR57 CR58 CR59\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePhantoms for imaging, calibration, and dosimetry purposes [\u003cspan additionalcitationids=\"CR62 CR63\" citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePhantoms for testing and validation of new surgical tools [\u003cspan additionalcitationids=\"CR66 CR67\" citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePhantoms for the simulation and visualization of pathological conditions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR70 CR71 CR72 CR73 CR74 CR75 CR76 CR77 CR78 CR79 CR80 CR81 CR82\" citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e]\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThe individual groups, along with the distribution of the 68 publications among them, are visualized in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe results indicate that approximately one-third of the identified publications employed phantoms for educational purposes or training in specific surgical procedures. Subsequent to this, applications pertaining to the visualization of pathological conditions, accounting for nearly one-fifth of the studies. The following materials (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) were utilized in the creation of the various simulation models, irrespective of the application areas.\u003c/p\u003e\u003cp\u003eThe data presented in the figure indicates that approximately half of all fabricated skull phantoms were produced using PLA. Subsequently, the ABS and various resins from Formlabs (White, Grey, and Clear) are utilized. A comprehensive overview of all materials and their corresponding printing technologies is provided in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eList of the materials used in the publications and their printing processes ([\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] was excluded - no specific information about the material (plaster powder) available)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaterial\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePrinting method\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePLA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePLA \u003csup\u003e[8, 18\u0026ndash;22, 27\u0026ndash;30, 39\u0026ndash;47, 61\u0026ndash;66, 69\u0026ndash;75]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ematerial extrusion\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eABS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eABS \u003csup\u003e[23, 24, 31\u0026ndash;33, 48, 49, 76]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ematerial extrusion\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eFormlabs-Resin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhite Resin \u003csup\u003e[25, 34, 50]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003einverted vat polymerization\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrey Resin \u003csup\u003e[35, 77]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClear Resin \u003csup\u003e[36, 78]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePlaster Powder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eZP\u0026nbsp;150 Powder \u003csup\u003e[26, 51, 79, 80]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ebinder jetting\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eZP\u0026nbsp;130 Powder \u003csup\u003e[52]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePolyJet Material\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMed610 Resin \u003csup\u003e[37]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ematerial Jetting\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVero White \u003csup\u003e[53\u0026ndash;55, 81]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003ePA12 basiert\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDuraform PA \u003csup\u003e[67]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003epowder bed fusion\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePA12 \u003csup\u003e[56]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePolyamid nylon with glass beads \u003csup\u003e[57]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePA2200 \u003csup\u003e[82]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVisiJet Material\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVisiJet PXL core \u003csup\u003e[38, 83]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ematerial jetting\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVisiJet C4 Spectrum \u003csup\u003e[58]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePET-G \u003csup\u003e[59]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003emetarial extrusion\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePVC \u003csup\u003e[68]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN.A.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEleegoo photopolymer resin \u003csup\u003e[60]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003einverted vat polymerization\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, the various materials are presented in relation to the previously defined application categories, allowing for the identification of potential trends. The data reveal that PLA is utilized across all categories. Furthermore, it is evident that the greatest variability in material choice is found within the domains of visualization and educational training.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePractical Testing on the Phantom\u003c/h3\u003e\n\u003cp\u003eA survey was conducted among nine neurosurgeons at the Department of Neurosurgery, University Hospital Leipzig, with the objective of evaluating the visual and haptic properties of the model. The assessment was conducted employing a Likert scale ranging from 0 to 10 (0\u0026thinsp;=\u0026thinsp;does not apply at all, poorly represented; 10\u0026thinsp;=\u0026thinsp;fully applies, highly realistic). The evaluation process entailed two craniotomies and the milling of a predefined area, simulating a retrosigmoid approach for the treatment of an acoustic neuroma.\u003c/p\u003e\u003cp\u003eThe results are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e. Overall, the material was rated as realistic, with a mean score of 7.2. One participant noted that the material appeared slightly too rigid and criticized the absence of an internal porous structure (spongiosa).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eA comprehensive review of the extant literature reveals a broad array of materials and printing technologies that have been employed. To provide a more comprehensive contextual analysis, Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e presents a graphical representation of the distribution of the various manufacturing methods.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eGiven the prevalence of PLA and ABS, material extrusion\u0026mdash;particularly the Fused Deposition Modeling (FDM) process\u0026mdash;emerges as the prevailing printing technique, accounting for approximately 60% of the cases. The phenomenon under discussion can be attributed to several factors. Firstly, the financial burden of materials and printers is relatively minimal. Secondly, there is a wide availability of suppliers and compatible materials. Thirdly, FDM devices are comparatively simple to operate and handle. Furthermore, FDM has become one of the most widely used additive manufacturing techniques around the world. The second most prevalent printing technologies are inverted vat polymerization and material jetting. These methods find application in resins from companies such as Formlabs, as well as in PolyJet and VisiJet materials. Despite the higher cost of these processes compared to FDM, they provide distinct advantages in terms of resolution and surface quality, enabling the fabrication of more intricate models. Additionally, material jetting enables the fabrication of multicolored models in a single print, a feature that is particularly advantageous for educational and demonstrative applications. Binder jetting and powder bed fusion\u0026mdash;particularly the Selective Laser Sintering (SLS) process\u0026mdash;are utilized with reduced frequency for the fabrication of neurosurgical skull phantoms. This occurrence can be attributed to the significant financial investments necessary for acquiring the essential equipment and materials, as well as the limited availability of suitable materials. Additionally, the post-processing, maintenance, and cleaning requirements for these devices are relatively intensive, rendering them less suitable for the production of individual models.\u003c/p\u003e\u003cp\u003eA comparison of the application domains (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e) with the materials employed reveals no direct correlation. A notable example is the field of education and hands-on training, where surgical procedures are simulated, exhibiting significant variability in the materials utilized. This variation can be attributed to several factors, such as cost, the availability of specific printers, and material accessibility. However, a paucity of publications has been observed in the extant literature regarding the evaluation of material properties during drilling or milling. This may be attributable to the fact that the skull replicas were principally designed for visual purposes or that manipulation with surgical instruments was not necessary. Consequently, a meticulous study was undertaken to assess the material that received the highest ratings during the preliminary selection process. The material was evaluated by an experienced neurosurgeon (White V4 by Formlabs) through a hands-on testing process conducted by multiple neurosurgeons. The material was generally well-received. Among the nine participants, two perceived the substance as moderately hard, with one specifically noting the absence of an internal porous structure (spongiosa). In contrast, three participants regarded it as somewhat too soft. The divergent evaluations can be attributed to a number of factors. One potential explanation for this observation is the anatomical location of the defined surgical access. The test entailed a retrosigmoid approach, which intersects with the mastoid bone by approximately one-third. This region of the cranium is characterized by substantial thickness, which complicates excision. In the present configuration, the drilling point was situated within this region, necessitating increased exertion and potentially impacting the subjective perception of drilling resistance. Another potential factor in the variability of responses is the wear of the craniotome used. It is important to note that a single craniotome, and thus a single cutting tool, was available for the entirety of the testing period. Consequently, it is plausible that the tool experienced wear over time, leading to subsequent participants perceiving the material as harder. Finally, and perhaps most significantly, individual subjective experience plays a critical role in interpreting the results. For instance, the influence of prior surgical interventions on the participant's evaluation is a potential confounding factor. In the event that a surgeon has recently performed surgery on a patient with particularly soft bone, a consequence of advanced age or other underlying conditions, the surgeon may assess the material as overly hard, or vice versa.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe utilization of three-dimensional printing in the fabrication of medical phantoms and simulation models has undergone a substantial increase over the past 15 years. This trend can be attributed to three factors. First, there has been a growing diversity of 3D printing technologies. Second, there has been an expansion of the range of materials. Third, there has been improved accessibility. In the design of such models, the creation of anatomically realistic visual and haptic representations is of paramount importance. To this end, a comprehensive literature review of PubMed-listed articles on 3D printed skull models was conducted to gain an overview of the materials used. A total of 68 publications were identified. The analysis revealed that nearly 50% of the skull models described in the articles\u0026mdash;regardless of their intended use\u0026mdash;were made from PLA. This was followed by ABS at approximately 13% and resins from the company Formlabs at 10%. The prevalence of PLA can be attributed to its compatibility with a straightforward and widely accessible printing process, as well as its comparatively low cost. However, it should be noted that PLA does possess the drawback of not always providing sufficient mechanical strength to realistically replicate cranial bone. To identify a suitable material for the skull phantom, test drilling was performed using a craniotome on various materials and printing methods that were available. Subsequent to the analysis of the results, a phantom was fabricated using the material that demonstrated the most promising results. The bone replica was subsequently evaluated by nine neurosurgeons at the University Hospital Leipzig. The evaluation utilized a custom-developed Likert scale to assess the strength and realism of the replica. The final phantom was produced using White V4 resin from Formlabs. The material in the study was evaluated as relatively realistic, receiving a rating of 7.2. However, a certain degree of variation in assessments was observed. Two participants perceived the material to be too hard in comparison to real bone, while three others found it to be too soft. This variability may be attributed, for example, to the wear of the cutting instrument used. Additionally, the evaluation process was inherently subjective and may have been influenced by prior surgical interventions or individual experiences.\u003c/p\u003e\u003cp\u003eIn summary, a range of materials can be utilized in the fabrication of skull models. The selection is influenced by several factors, including cost, compatible printing technologies, and intended application. The present study demonstrated that White V4 from Formlabs is a suitable material for replicating drillable cranial bone.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are given in the paper and can be received on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOpen Access funding enabled and organized by Project DEAL. The study was carried out as part of project 16KN081071 under the ZIM funding program of the German Federal Ministry for Economic Affairs and Climate Protection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor Svenja Jung wrote the main manuscript and is responsible for the research and the 3D printing. Svenja Jung is also co-responsible for the design process of the simulation model. Maike Stummer is responsible for the construction of the simulation model and co-responsible for the design process. Dirk Winkler, Erdem G\u0026uuml;resir and Felix Arlt accompanied the clinical part of the study and provided their expertise in the medical background. Ronny Grunert and Felix Arlt prepared the methodology of the project.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003cstrong\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBai W, Fang H, Wang Y et al. (2021) Academic Insights and Perspectives in 3D Printing: A Bibliometric Review. Applied Sciences 11:8298. https://doi.org/10.3390/app11188298\u003c/li\u003e\n\u003cli\u003eMommaerts MY, Depauw PR, Nout E (2020) Ceramic 3D-Printed Titanium Cranioplasty. Craniomaxillofac Trauma Reconstr 13:329\u0026ndash;333. https://doi.org/10.1177/1943387520927916\u003c/li\u003e\n\u003cli\u003eSeraj FQM, Kheradmand D, Najafi S et al. (2025) Customized 3D-printed Poly ether ether ketone cranial implant for cranioplasty of skull defects. Neurosurg Rev 48:301. https://doi.org/10.1007/s10143-025-03448-7\u003c/li\u003e\n\u003cli\u003eKropla F, Hoffmann M, Winkler D et al. (2023) Development of an individual helmet orthosis for infants based on a 3D scan. 3D Print Med 9:22. https://doi.org/10.1186/s41205-023-00187-7\u003c/li\u003e\n\u003cli\u003eChen C-S, Chang Y-S, Lin K-W et al. (2024) Biomechanical evaluation of 3D-printed joint-type orthosis for hallux valgus. J Chin Med Assoc 87:809\u0026ndash;814. https://doi.org/10.1097/JCMA.0000000000001120\u003c/li\u003e\n\u003cli\u003eHonigmann P, Sharma N, Schumacher R et al. (2021) In-Hospital 3D Printed Scaphoid Prosthesis Using Medical-Grade Polyetheretherketone (PEEK) Biomaterial. Biomed Res Int 2021:1301028. https://doi.org/10.1155/2021/1301028\u003c/li\u003e\n\u003cli\u003eCui Y, Chen B, Wang G et al. (2023) Partial talar replacement with a novel 3D printed prosthesis. Comput Assist Surg (Abingdon) 28:2198106. https://doi.org/10.1080/24699322.2023.2198106\u003c/li\u003e\n\u003cli\u003eDissanayaka N, Maclachlan LR, Alexander H et al. (2023) Evaluation of 3D Printed Burr Hole Simulation Models Using 8 Different Materials. World Neurosurg 176:e651-e663. https://doi.org/10.1016/j.wneu.2023.05.115\u003c/li\u003e\n\u003cli\u003eZhang J, Tian W, Chen J et al. (2019) The application of polyetheretherketone (PEEK) implants in cranioplasty. Brain Res Bull 153:143\u0026ndash;149. https://doi.org/10.1016/j.brainresbull.2019.08.010\u003c/li\u003e\n\u003cli\u003eSu Q, Qiao Y, Xiao Y et al. (2023) Research progress of 3D printed poly (ether ether ketone) in the reconstruction of craniomaxillofacial bone defects. Front Bioeng Biotechnol 11:1259696. https://doi.org/10.3389/fbioe.2023.1259696\u003c/li\u003e\n\u003cli\u003eFormlabs GmbH Tough 1500\u003c/li\u003e\n\u003cli\u003eFormlabs GmbH General Purpose Resins\u003c/li\u003e\n\u003cli\u003eFormlabs GmbH BioMed White\u003c/li\u003e\n\u003cli\u003ePolymaker PolyTerra\u003csup\u003eTM\u003c/sup\u003e PLA: Technical Data Sheet\u003c/li\u003e\n\u003cli\u003eBASF SE Ultrafuse PA: Technical Data Sheet\u003c/li\u003e\n\u003cli\u003eHP Development Company HP 3D High Reusability PA 12\u003c/li\u003e\n\u003cli\u003eReinacher PC, Kr\u0026uuml;ger MT, Coenen VA et al. (2017) Determining the Orientation of Directional Deep Brain Stimulation Electrodes Using 3D Rotational Fluoroscopy. AJNR Am J Neuroradiol 38:1111\u0026ndash;1116. https://doi.org/10.3174/ajnr.A5153\u003c/li\u003e\n\u003cli\u003eWan S, Rodrigues DB, Kwiatkowski J et al. (2023) Evaluation of a Balloon Implant for Simultaneous Magnetic Nanoparticle Hyperthermia and High-Dose-Rate Brachytherapy of Brain Tumor Resection Cavities. Cancers (Basel) 15. https://doi.org/10.3390/cancers15235683\u003c/li\u003e\n\u003cli\u003eCao F, Gao Z, Qi S et al. (2023) Realistic three-layer head phantom for optically pumped magnetometer-based magnetoencephalography. Comput Biol Med 164:107318. https://doi.org/10.1016/j.compbiomed.2023.107318\u003c/li\u003e\n\u003cli\u003eEom S, Ma TS, Vutakuri N et al. (2024) Accuracy of routine external ventricular drain placement following a mixed reality-guided twist-drill craniostomy. Neurosurg Focus 56:E11. https://doi.org/10.3171/2023.10.FOCUS23615\u003c/li\u003e\n\u003cli\u003eMukwada G, Hirst A, Rowshanfarzad P et al. (2024) Development of a 3D printed phantom for commissioning and quality assurance of multiple brain targets stereotactic radiosurgery. Phys Eng Sci Med 47:455\u0026ndash;463. https://doi.org/10.1007/s13246-023-01374-w\u003c/li\u003e\n\u003cli\u003evan Doormaal JAM, Fick T, Boskovic E et al. (2025) Development and Validation of a Neurosurgical Phantom for Simulating External Ventricular Drain Placement. J Med Syst 49:1. https://doi.org/10.1007/s10916-024-02133-4\u003c/li\u003e\n\u003cli\u003eMenikou G, Dadakova T, Pavlina M et al. (2015) MRI compatible head phantom for ultrasound surgery. Ultrasonics 57:144\u0026ndash;152. https://doi.org/10.1016/j.ultras.2014.11.004\u003c/li\u003e\n\u003cli\u003eAntoniou A, Damianou C (2024) Feasibility of Ultrasonic Heating through Skull Phantom Using Single-element Transducer. J Med Ultrasound 32:32\u0026ndash;40. https://doi.org/10.4103/jmu.jmu_3_23\u003c/li\u003e\n\u003cli\u003eCivilla L, Dodier P, Palumbo MC et al. (2024) Development and assessment of case-specific physical and augmented reality simulators for intracranial aneurysm clipping. 3D Print Med 10:30. https://doi.org/10.1186/s41205-024-00235-w\u003c/li\u003e\n\u003cli\u003eLi H, Chen RK, Tang Y et al. (2018) An experimental study and finite element modeling of head and neck cooling for brain hypothermia. J Therm Biol 71:99\u0026ndash;111. https://doi.org/10.1016/j.jtherbio.2017.10.022\u003c/li\u003e\n\u003cli\u003eMendez BM, Chiodo MV, Patel PA (2015) Customized \u0026quot;In-Office\u0026quot; Three-Dimensional Printing for Virtual Surgical Planning in Craniofacial Surgery. J Craniofac Surg 26:1584\u0026ndash;1586. https://doi.org/10.1097/SCS.0000000000001768\u003c/li\u003e\n\u003cli\u003eMackle EC, Shapey J, Maneas E et al. (2020) Patient-Specific Polyvinyl Alcohol Phantom Fabrication with Ultrasound and X-Ray Contrast for Brain Tumor Surgery Planning. J Vis Exp. https://doi.org/10.3791/61344\u003c/li\u003e\n\u003cli\u003eUzunoglu I, Kızmazoglu C, Husemoglu RB et al. (2021) Three-Dimensional Printing Assisted Preoperative Surgical Planning for Cerebral Arteriovenous Malformation. J Korean Neurosurg Soc 64:882\u0026ndash;890. https://doi.org/10.3340/jkns.2021.0016\u003c/li\u003e\n\u003cli\u003eZahid F, Memon A, Siddiqui M et al. (2024) Successful use of a patient specific 3D-printed biomodel as surgical guide for excision of juvenile nasopharyngeal angiofibroma extending to skull base: A case report. Surg Neurol Int 15:44. https://doi.org/10.25259/SNI_743_2023\u003c/li\u003e\n\u003cli\u003eHuang X, Fan N, Wang H-J et al. (2021) Application of 3D printed model for planning the endoscopic endonasal transsphenoidal surgery. Sci Rep 11:5333. https://doi.org/10.1038/s41598-021-84779-5\u003c/li\u003e\n\u003cli\u003eDuan H, Jiang X, Li C et al. (2022) Application of a three-dimensional printed model to localize a cranial cerebrospinal fluid leak: a case report. J Int Med Res 50:3000605221078412. https://doi.org/10.1177/03000605221078412\u003c/li\u003e\n\u003cli\u003eChen P-C, Yang Y-W, Lin J-C et al. (2022) Advanced Manufacturing in the Fabrication of a Lifelike Brain Glioblastoma Simulator for the Training of Neurosurgeons. Polymers (Basel) 14. https://doi.org/10.3390/polym14061072\u003c/li\u003e\n\u003cli\u003ePanesar SS, Magnetta M, Mukherjee D et al. (2019) Patient-specific 3-dimensionally printed models for neurosurgical planning and education. Neurosurg Focus 47:E12. https://doi.org/10.3171/2019.9.FOCUS19511\u003c/li\u003e\n\u003cli\u003eGrau S, Kellermann S, Faust M et al. (2018) Repair of Cerebrospinal Fluid Leakage Using a Transfrontal, Radial Adipofascial Flap: An Individual Approach Supported by Three-Dimensional Printing for Surgical Planning. World Neurosurg 110:315\u0026ndash;318. https://doi.org/10.1016/j.wneu.2017.11.083\u003c/li\u003e\n\u003cli\u003eMarques MA, Purnell CA, Zhao L et al. (2023) Patient-specific Composite Anatomic Models: Improving the Foundation for Craniosynostosis Repair. J Craniofac Surg 34:1078\u0026ndash;1081. https://doi.org/10.1097/SCS.0000000000009182\u003c/li\u003e\n\u003cli\u003eLangdon C, Hinojosa-Bernal J, Munuera J et al. (2023) 3D printing as surgical planning and training in pediatric endoscopic skull base surgery - Systematic review and practical example. Int J Pediatr Otorhinolaryngol 168:111543. https://doi.org/10.1016/j.ijporl.2023.111543\u003c/li\u003e\n\u003cli\u003eEisenmenger LB, Wiggins RH, Fults DW et al. (2017) Application of 3-Dimensional Printing in a Case of Osteogenesis Imperfecta for Patient Education, Anatomic Understanding, Preoperative Planning, and Intraoperative Evaluation. World Neurosurg 107:1049.e1-1049.e7. https://doi.org/10.1016/j.wneu.2017.08.026\u003c/li\u003e\n\u003cli\u003eBannon R, Parihar S, Skarparis Y et al. (2018) 3D printing the pterygopalatine fossa: a negative space model of a complex structure. Surg Radiol Anat 40:185\u0026ndash;191. https://doi.org/10.1007/s00276-017-1916-x\u003c/li\u003e\n\u003cli\u003eGarling RJ, Jin X, Yang J et al. (2018) Low-cost endoscopic third ventriculostomy simulator with mimetic endoscope. J Neurosurg Pediatr 22:137\u0026ndash;146. https://doi.org/10.3171/2018.2.PEDS17671\u003c/li\u003e\n\u003cli\u003eShen Z, Yao Y, Xie Y et al. (2019) The process of 3D printed skull models for anatomy education. Comput Assist Surg (Abingdon) 24:121\u0026ndash;130. https://doi.org/10.1080/24699322.2018.1560101\u003c/li\u003e\n\u003cli\u003eDuda S, Meyer L, Musienko E et al. (2020) The Manufacturing of 3D Printed models for the Neurotraumatological Education of Military Surgeons. Mil Med 185:e2013-e2019. https://doi.org/10.1093/milmed/usaa183\u003c/li\u003e\n\u003cli\u003eLicci M, Thieringer FM, Guzman R et al. (2020) Development and validation of a synthetic 3D-printed simulator for training in neuroendoscopic ventricular lesion removal. Neurosurg Focus 48:E18. https://doi.org/10.3171/2019.12.FOCUS19841\u003c/li\u003e\n\u003cli\u003eNebor I, Hussein AE, Montemagno K et al. (2022) Primary Dural Repair via an Endoscopic Endonasal Corridor: Preliminary Development of a 3D-Printed Model for Training. J Neurol Surg B Skull Base 83:e260-e265. https://doi.org/10.1055/s-0041-1725027\u003c/li\u003e\n\u003cli\u003eByvaltsev V, Polkin R, Bereznyak D et al. (2021) 3D-printed cranial models simulating operative field depth for microvascular training in neurosurgery. Surg Neurol Int 12:213. https://doi.org/10.25259/SNI_849_2020\u003c/li\u003e\n\u003cli\u003eEntezami P, Spurgas MP, O\u0026apos;Brien MW et al. (2022) Utility of 3-dimensionally printed models for parent education in pediatric plagiocephaly. PEC Innov 1:100077. https://doi.org/10.1016/j.pecinn.2022.100077\u003c/li\u003e\n\u003cli\u003eJeising S, Liu S, Blaszczyk T et al. (2024) Combined use of 3D printing and mixed reality technology for neurosurgical training: getting ready for brain surgery. Neurosurg Focus 56:E12. https://doi.org/10.3171/2023.10.FOCUS23611\u003c/li\u003e\n\u003cli\u003eMooney MA, Cavallo C, Zhou JJ et al. (2020) Three-Dimensional Printed Models for Lateral Skull Base Surgical Training: Anatomy and Simulation of the Transtemporal Approaches. Oper Neurosurg (Hagerstown) 18:193\u0026ndash;201. https://doi.org/10.1093/ons/opz120\u003c/li\u003e\n\u003cli\u003eBelykh E, Abramov I, Bardonova L et al. (2023) Seven bypasses simulation set: description and validity assessment of novel models for microneurosurgical training. J Neurosurg 138:732\u0026ndash;739. https://doi.org/10.3171/2022.5.JNS22465\u003c/li\u003e\n\u003cli\u003eFreiser ME, Ghodadra A, Hirsch BE et al. (2019) Evaluation of 3D Printed Temporal Bone Models in Preparation for Middle Cranial Fossa Surgery. Otol Neurotol 40:246\u0026ndash;253. https://doi.org/10.1097/MAO.0000000000002073\u003c/li\u003e\n\u003cli\u003eKondo K, Nemoto M, Masuda H et al. (2015) Anatomical Reproducibility of a Head Model Molded by a Three-dimensional Printer. Neurol Med Chir (Tokyo) 55:592\u0026ndash;598. https://doi.org/10.2176/nmc.oa.2014-0436\u003c/li\u003e\n\u003cli\u003eMashiko T, Kaneko N, Konno T et al. (2017) Training in Cerebral Aneurysm Clipping Using Self-Made 3-Dimensional Models. J Surg Educ 74:681\u0026ndash;689. https://doi.org/10.1016/j.jsurg.2016.12.010\u003c/li\u003e\n\u003cli\u003eSaleh Y, Piper R, Richard M et al. (2022) Designing a 3D Printed Model of the Skull-Base: A Collaboration Between Clinicians and Industry. J Med Educ Curric Dev 9:23821205221080703. https://doi.org/10.1177/23821205221080703\u003c/li\u003e\n\u003cli\u003eWatanabe N, Watanabe K, Fujimura S et al. (2023) Real Stiffness and Vividness Reproduction of Anatomic Structures Into the 3-Dimensional Printed Models Contributes to Improved Simulation and Training in Skull Base Surgery. Oper Neurosurg (Hagerstown) 24:548\u0026ndash;555. https://doi.org/10.1227/ons.0000000000000583\u003c/li\u003e\n\u003cli\u003eRahmani R, Santangelo G, Jalal MI et al. (2024) A Simple 3D Printed Model for Intracranial Vascular Anastomosis Practice and the Rochester Bypass Training Score. Oper Neurosurg (Hagerstown) 26:341\u0026ndash;345. https://doi.org/10.1227/ons.0000000000000931\u003c/li\u003e\n\u003cli\u003eScheidt K, Kropla F, Winkler D et al. (2025) 3D-printed skull model for enhancing training in external ventricular drainage within medical education. 3D Print Med 11:16. https://doi.org/10.1186/s41205-025-00263-0\u003c/li\u003e\n\u003cli\u003eWanibuchi M, Noshiro S, Sugino T et al. (2016) Training for Skull Base Surgery with a Colored Temporal Bone Model Created by Three-Dimensional Printing Technology. World Neurosurg 91:66\u0026ndash;72. https://doi.org/10.1016/j.wneu.2016.03.084\u003c/li\u003e\n\u003cli\u003eEastwood KW, Bodani VP, Haji FA et al. (2018) Development of synthetic simulators for endoscope-assisted repair of metopic and sagittal craniosynostosis. J Neurosurg Pediatr 22:128\u0026ndash;136. https://doi.org/10.3171/2018.2.PEDS18121\u003c/li\u003e\n\u003cli\u003eChen J, Kumar S, Shallal C et al. (2022) Caregiver Preferences for Three-Dimensional Printed or Augmented Reality Craniosynostosis Skull Models: A Cross-Sectional Survey. J Craniofac Surg 33:151\u0026ndash;155. https://doi.org/10.1097/SCS.0000000000008134\u003c/li\u003e\n\u003cli\u003ePiazza A, Corvino S, Colosso GQ et al. (2024) 3-Dimensional Printed Model of the Temporal Bone for Neurosurgical Training. Oper Neurosurg (Hagerstown) 27:749\u0026ndash;755. https://doi.org/10.1227/ons.0000000000001213\u003c/li\u003e\n\u003cli\u003eAvery J, Aristovich K, Low B et al. (2017) Reproducible 3D printed head tanks for electrical impedance tomography with realistic shape and conductivity distribution. Physiol Meas 38:1116\u0026ndash;1131. https://doi.org/10.1088/1361-6579/aa6586\u003c/li\u003e\n\u003cli\u003eChurch C, Parsons D, Syme A (2022) Region-of-interest intra-arc MV imaging to facilitate sub-mm positional accuracy with minimal imaging dose during treatment deliveries of small cranial lesions. J Appl Clin Med Phys 23:e13769. https://doi.org/10.1002/acm2.13769\u003c/li\u003e\n\u003cli\u003eLai M, Skyrman S, Kor F et al. (2022) Development of a CT-Compatible, Anthropomorphic Skull and Brain Phantom for Neurosurgical Planning, Training, and Simulation. Bioengineering (Basel) 9. https://doi.org/10.3390/bioengineering9100537\u003c/li\u003e\n\u003cli\u003eEndarko E, Pitaloka AW, Inayah AA et al. (2023) Evaluation of 3D Printed Anthropomorphic Head Phantom for Calibration of TLD in Eye Lens Dosimeter. J Biomed Phys Eng 13:193\u0026ndash;202. https://doi.org/10.31661/jbpe.v0i0.2109-1401\u003c/li\u003e\n\u003cli\u003eSkyrman S, Lai M, Edstr\u0026ouml;m E et al. (2021) Augmented reality navigation for cranial biopsy and external ventricular drain insertion. Neurosurg Focus 51:E7. https://doi.org/10.3171/2021.5.FOCUS20813\u003c/li\u003e\n\u003cli\u003eKhan RI, McElhinney K, Dickson A et al. (2024) Image-guided orbital surgery: a preclinical validation study using a high-resolution physical model. BMJ Open Ophthalmol 9. https://doi.org/10.1136/bmjophth-2023-001568\u003c/li\u003e\n\u003cli\u003eVakharia VN, Rodionov R, McEvoy AW et al. (2019) Improving patient safety during introduction of novel medical devices through cumulative summation analysis. J Neurosurg 130:213\u0026ndash;219. https://doi.org/10.3171/2017.8.JNS17936\u003c/li\u003e\n\u003cli\u003eCui M, Ren W, Cui T et al. (2024) Design of intelligent human-machine collaborative robot-assisted craniotomy system. Heliyon 10:e40364. https://doi.org/10.1016/j.heliyon.2024.e40364\u003c/li\u003e\n\u003cli\u003eNaftulin JS, Kimchi EY, Cash SS (2015) Streamlined, Inexpensive 3D Printing of the Brain and Skull. PLoS One 10:e0136198. https://doi.org/10.1371/journal.pone.0136198\u003c/li\u003e\n\u003cli\u003eGadaleta DJ, Huang D, Rankin N et al. (2020) 3D printed temporal bone as a tool for otologic surgery simulation. Am J Otolaryngol 41:102273. https://doi.org/10.1016/j.amjoto.2019.08.004\u003c/li\u003e\n\u003cli\u003eShen Z, Xie Y, Shang X et al. (2020) The manufacturing procedure of 3D printed models for endoscopic endonasal transsphenoidal pituitary surgery. Technol Health Care 28:131\u0026ndash;150. https://doi.org/10.3233/THC-209014\u003c/li\u003e\n\u003cli\u003eNebor I, Anderson Z, Mejia-Munne JC et al. (2022) 2D versus 3D Endoscopy: Head-to-Head Comparison in a Simulated Model of Endoscopic Endonasal Dural Suturing. J Neurol Surg B Skull Base 83:423\u0026ndash;429. https://doi.org/10.1055/s-0041-1736635\u003c/li\u003e\n\u003cli\u003eMian SY, Jayasangaran S, Qureshi A et al. (2023) Exploring the Impact of Using Patient-Specific 3D Prints during Consent for Skull Base Neurosurgery. J Neurol Surg B Skull Base 84:463\u0026ndash;469. https://doi.org/10.1055/a-1885-1111\u003c/li\u003e\n\u003cli\u003eSidabutar R, Yudha TW, Sutiono AB et al. (2023) Low-cost and open-source three-dimensional (3D) printing in neurosurgery: A pilot experiment using direct drive modification to produce multi-material neuroanatomical models. Clin Neurol Neurosurg 228:107684. https://doi.org/10.1016/j.clineuro.2023.107684\u003c/li\u003e\n\u003cli\u003eKrivankova B, Burns M, Gasser I et al. (2024) Repair of lateral temporo-sphenoidal encephalocoele via an endoscopic transorbital approach: ex vivo 3D printed simulation followed by in vivo deployment. Br J Neurosurg:1\u0026ndash;6. https://doi.org/10.1080/02688697.2023.2297878\u003c/li\u003e\n\u003cli\u003eLee MH, Lee T-K (2022) Cadaver-Free Neurosurgical Simulation Using a 3-Dimensional Printer and Augmented Reality. Oper Neurosurg (Hagerstown) 23:46\u0026ndash;52. https://doi.org/10.1227/ons.0000000000000184\u003c/li\u003e\n\u003cli\u003eChae R, Sharon JD, Kournoutas I et al. (2020) Replicating Skull Base Anatomy With 3D Technologies: A Comparative Study Using 3D-scanned and 3D-printed Models of the Temporal Bone. Otol Neurotol 41:e392-e403. https://doi.org/10.1097/MAO.0000000000002524\u003c/li\u003e\n\u003cli\u003eJimenez JE, Shaffer AD, Hammersley E et al. (2023) Use of patient-specific 3D printed models in pre-operative counseling for pediatric skull base surgery. Int J Pediatr Otorhinolaryngol 171:111655. https://doi.org/10.1016/j.ijporl.2023.111655\u003c/li\u003e\n\u003cli\u003eNagassa RG, McMenamin PG, Adams JW et al. (2019) Advanced 3D printed model of middle cerebral artery aneurysms for neurosurgery simulation. 3D Print Med 5:11. https://doi.org/10.1186/s41205-019-0048-9\u003c/li\u003e\n\u003cli\u003eKondo K, Nemoto M, Harada N et al. (2019) Three-Dimensional Printed Model for Surgical Simulation of Combined Transpetrosal Approach. World Neurosurg 127:e609-e616. https://doi.org/10.1016/j.wneu.2019.03.219\u003c/li\u003e\n\u003cli\u003eHsieh T-Y, Cervenka B, Dedhia R et al. (2018) Assessment of a Patient-Specific, 3-Dimensionally Printed Endoscopic Sinus and Skull Base Surgical Model. JAMA Otolaryngol Head Neck Surg 144:574\u0026ndash;579. https://doi.org/10.1001/jamaoto.2018.0473\u003c/li\u003e\n\u003cli\u003eGhizoni E, Souza JPSAS de, Raposo-Amaral CE et al. (2018) 3D-Printed Craniosynostosis Model: New Simulation Surgical Tool. World Neurosurg 109:356\u0026ndash;361. https://doi.org/10.1016/j.wneu.2017.10.025\u003c/li\u003e\n\u003cli\u003eLondon NR, Rangel GG, VanKoevering K et al. (2021) Simulation of Pediatric Anterior Skull Base Anatomy Using a 3D Printed Model. World Neurosurg 147:e405-e410. https://doi.org/10.1016/j.wneu.2020.12.077\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"3d-printing-in-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tdpm","sideBox":"Learn more about [3D Printing in Medicine](https://threedmedprint.biomedcentral.com/)","snPcode":"41205","submissionUrl":"https://submission.nature.com/new-submission/41205/3","title":"3D Printing in Medicine","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"3D print, 3D printed head phantom, neurosurigal phantom, head phantom, phantom, additve manufacturing","lastPublishedDoi":"10.21203/rs.3.rs-6991325/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6991325/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eIn the preceding 15 years, the implementation of 3D printing has undergone a steady increase across a variety of disciplines. In the medical domain, its use has become particularly prominent, for instance in the development of anatomical phantoms to visualize pathological conditions or to evaluate new surgical procedures. In order to identify a material that specifically mimics cranial bone, a literature review of existing skull phantoms was conducted. This was followed by a pilot study using a custom-developed phantom of the posterior fossa for the evaluation of a suitable material.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA literature search was conducted using the PubMed database for existing 3D printed skull phantoms. The search terms \"3D printed,\" \"skull phantom,\" and \"neurosurgery,\" among others, were utilized. A total of 1,741 publications were identified in the initial review. The initial pool of articles was then narrowed down based on several inclusion criteria, including language. For the experimental study on the phantom, test blocks made from various materials were produced and subjected to craniotomy procedures. The materials were evaluated by an experienced neurosurgeon based on their drilling characteristics. The highest-rated material (White V4 resin by Formlabs) was selected for the fabrication of the final skull phantom.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 68 articles satisfied the inclusion criteria and were thus included in the analysis. The results indicated that approximately half of all phantoms, irrespective of their intended application, were fabricated using PLA. Subsequent to this, ABS and various resins from Formlabs were introduced. For the material evaluation study, nine neurosurgeons were tasked with performing a craniotomy on the phantom and assessing the material in comparison to real bone. The material (White V4 by Formlabs) was evaluated using a self-selected Likert scale, resulting in an average rating of 7.2 out of 10 points. This rating indicates that the material is deemed suitable.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe findings demonstrate that the materials used for the fabrication of skull phantoms vary significantly depending on multiple factors. However, the material testing conducted in this study led to the identification of a resin that offers favorable properties both in terms of manufacturing feasibility and cost-efficiency. This material can effectively serve as a bone substitute for neurosurgical training purposes. The results of this study may serve as a foundation for the future development of skull models, particularly in contexts where drilling characteristics similar to those of real bone are desired.\u003c/p\u003e","manuscriptTitle":"Suitable materials for the creation of neurosurgical phantoms using the example of a 3D printed simulation model of the posterior fossa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 09:54:58","doi":"10.21203/rs.3.rs-6991325/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"279237181902820598193135583257078395335","date":"2025-09-10T04:04:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"207481946209067803896658033029110162424","date":"2025-09-10T03:55:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-01T06:17:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-30T03:25:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-30T03:23:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"3D Printing in Medicine","date":"2025-06-27T11:43:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"3d-printing-in-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tdpm","sideBox":"Learn more about [3D Printing in Medicine](https://threedmedprint.biomedcentral.com/)","snPcode":"41205","submissionUrl":"https://submission.nature.com/new-submission/41205/3","title":"3D Printing in Medicine","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"349e0b14-d628-421b-9fd8-d1a2cfab0087","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-09T09:54:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 09:54:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6991325","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6991325","identity":"rs-6991325","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}