BOSTON, July 31, 2015 /PRNewswire-USNewswire/
-- Boston Children's Hospital physicians report the first
cases of children benefiting from 3D printing of their anatomy
before undergoing high-risk brain procedures. The four children had
life-threatening cerebrovascular malformations (abnormalities in
the brain's blood vessels) that posed special treatment
challenges.
Reporting online today in the Journal of Neurosurgery:
Pediatrics, the physicians describe the use of 3D printing and
synthetic resins to create custom, high-fidelity models of the
children's vessel malformations along with nearby normal blood
vessels. In some cases, the surrounding brain anatomy was also
printed.
"These children had unique anatomy with deep vessels that were
very tricky to operate on," says Boston Children's neurosurgeon
Edward Smith, MD, senior author of the paper and co-director of the
hospital's Cerebrovascular Surgery and Interventions Center. "The
3D-printed models allowed us to rehearse the cases beforehand and
reduce operative risk as much as we could."
The children ranged in age from 2 months to 16 years old. Three
of the four children had arteriovenous malformations (AVMs), in
which tangles of arteries and veins connect abnormally, and were
treated surgically.
"AVMs are high-risk cases and it's helpful to know the anatomy
so we can cut the vessels in the right sequence, as quickly and
efficiently as possible," says Smith. "You can physically hold the
3D models, view them from different angles, practice the operation
with real instruments and get tactile feedback."
The 2-month-old infant had a rare vein of Galen malformation in
which arteries connect directly with veins—bypassing the
capillaries—and was treated with an interventional radiology
technique to seal off the malformed blood vessels from the
inside.
"Even for a radiologist who is comfortable working with and
extrapolating from images on the computer to the patient, turning
over a 3D model in your hand is transformative," says Darren
Orbach, MD, PhD, chief of Interventional and Neurointerventional
Radiology at Boston Children's and co-director of the
Cerebrovascular Surgery and Interventions Center. "Our brains work
in three dimensions, and treatment planning with a printed model
takes on an intuitive feel that it cannot otherwise have."
The life-sized and enlarged 3D models were created in
collaboration with the Boston Children's Hospital Simulator Program
(SIMPeds) using brain magnetic resonance (MR) and MR arteriography
data from each child. Measurements of the models showed 98 percent
agreement with the children's actual anatomy.
All four children's malformations were successfully removed or
eliminated with no complications. When two of the AVM patients were
compared with controls who did not have 3D-printed models—matched
for age, size and type of AVM, surgeon and operating room—those
with 3D models had their surgical time reduced by 12 percent (30
minutes). (Actual surgical time was 254 and 257 minutes for the
cases with 3D models and 285 and 288 minutes for the controls.)
Even a 30-minute reduction is significant for children who are
especially sensitive to anesthesia.
Smith and Orbach are continuing to use 3D models for their
trickier cases. "3D printing has become a regular part of our
process," says Smith. "It's also a tool that allows us to educate
our junior colleagues and trainees in a way that's safe, without
putting a child at risk."
SIMPeds director Peter Weinstock, MD, PhD, was first author on
the paper; co-authors were Orbach, Sanjay
Prabhu, MBBS, FRCR, and Katie
Flynn, BS, ME, all of Boston Children's Hospital. The study
was supported by the Lucas Warner AVM Research Fund and The Kids At
Heart Neurosurgery Research Fund.
Boston Children's Hospital is home to the world's largest
research enterprise based at a pediatric medical center, where its
discoveries have benefited both children and adults since 1869.
More than 1,100 scientists, including seven members of the
National Academy of Sciences, 11 members of the Institute
of Medicine and 10 members of the Howard Hughes Medical
Institute comprise Boston Children's research community. Founded as
a 20-bed hospital for children, Boston Children's today is a
397-bed comprehensive center for pediatric and adolescent health
care. Boston Children's is also the pediatric teaching affiliate of
Harvard Medical School. For more, visit our Vector
and Thriving blogs and follow us on our
social media channels: @BostonChildrens,
@BCH_Innovation, Facebook and
YouTube.
CONTACT: Keri Stedman or
Bethany Tripp
Boston Children's Hospital
617-919-3110
keri.stedman@childrens.harvard.edu |
bethany.tripp@childrens.harvard.edu
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SOURCE Boston Children's Hospital