Utility of 3D-printed models in preoperative simulation and spatial recognition for cavernous sinus dural arteriovenous fistulas

Background Transvenous embolization is the standard treatment for cavernous sinus dural arteriovenous fistulas (CS DAVFs). In some patients with CS DAVFs, selective embolization is possible if the shunted pouches can be accurately identified, avoiding the risk of cranial nerve damage due to excess coil use. Purpose To evaluate the utility of three-dimensional (3D)-printed models in enhancing the spatial understanding of shunted pouches and approach routes and facilitating selective embolization for CS DAVFs. Material and Methods The 3D-printed models of the CS of five patients with CS DAVFs treated between 2022 and 2024 were printed with fused deposition modeling 3D printers using 3D data from 3D digital subtraction angiography (3D-DSA). Shunted pouches were identified using high-resolution cone-beam computed tomography and four-dimensional DSA. Embolization procedures were planned based on the tactile and spatial understanding provided by 3D-DSA and 3D-printed models. Five patients treated between 2018 and 2022 without 3D-printed models were used as controls. Results Complete shunt obliteration was observed in all five patients whose CS was 3D-printed. Two patients were treated successfully with selective embolization of the shunted pouch alone and three patients required additional partial sinus packing. In the control group, selective embolization was possible in only one patient, and only two patients achieved complete obliteration, including one requiring retreatment due to early recanalization. Conclusion The use of 3D-printed models for CS DAVFs treatment may improve shunt point recognition and facilitate effective selective embolization.