Optimizing cerebrovascular surgical and endovascular procedures in children via personalized 3D printing
Optimizing cerebrovascular surgical and endovascular procedures in children via personalized 3D printing
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DOI：
10.3171/2015.3.peds14677
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发表时间：
2015-11-01
影响因子：
1.9
通讯作者：
Smith, Edward
中科院分区：
文献类型：
--
作者：
Weinstock, Peter;Prabhu, Sanjay P.;Smith, Edward
尽管多平面成像技术的可用性，理解复杂脑血管病变的相关三维解剖结构可能是困难的。3D打印模型允许从所有角度即时可视化病变解剖结构，并增加了通过触觉反馈模拟手术方法的能力。作者报告了他们的经验与定制的3D打印模型的小儿脑血管病变作为一种教育和临床工具，为病人，学员和医生。用专门的软件处理患有动静脉畸形（AVM）的儿科患者的磁共振成像（MRI）和计算机断层扫描（CT）研究，并且由外科/血管内团队选择感兴趣的区域。然后在3D打印机上打印每个患者的多个模型，每个结构旨在说明特定病变的不同方面。模型保真度的术中验证进行了围手术期成像，手术拍摄，事后分析模型与术中photography.Results四例涉及儿科患者（年龄0-16岁）进行了研究的初步证明的原则。其中3例患者患有AVM，1例患者患有Galen畸形静脉（VOGM）。VOGM栓塞成功，AVM切除无并发症。在AVM病例中，进行了术中成像和摄影，并验证了模型的毫米级保真度（n = 5，一致性98%，范围94%-100%，最大AVM [6 cm直径]的平均变化< 2 mm）。3D模型的使用与30分钟的手术时间减少（12%）在2例，当他们与匹配的控制作为一个可行性study.Conclusions患者特异性的3D打印模型的儿科脑血管疾病可以构建高保真度。该原理验证系列首次证实了使用术中评估确认模型准确性以及通过缩短手术时间获得的潜在受益。
OBJECT Despite the availability of multiplanar imaging, understanding relational 3D anatomy for complex cerebrovascular lesions can be difficult. A 3D printed model allows for instantaneous visualization of lesional anatomy from all perspectives, with the added ability to simulate operative approaches with tactile feedback. The authors report their experience with customized 3D printed models of pediatric cerebrovascular lesions as an educational and clinical tool for patients, trainees, and physicians.METHODS Via an "in-house" 3D print service; magnetic resonance imaging (MRI) and computerized tomography (CT) studies of pediatric patients with arteriovenous malformations (AVMs) were processed with specialized software, and regions of interest were selected by the surgical/endovascular team. Multiple models for each patient were then printed on a 3D printer, with each construct designed to illustrate different aspects of the specific lesion. Intraoperative validation of model fidelity was performed using perioperative imaging, surgical filming, and post hoc analysis of models with intraoperative photography.RESULTS Four cases involving pediatric patients (ages 0-16 years) were studied for initial proof of principle. Three of the patients had AVMs and one had a vein of Galen malformation (VOGM). The VOGM was embolized successfully and the AVMs were resected without complication. In the AVM cases, intraprocedural imaging and photography were performed and verified millimeter-level fidelity of the models (n = 5, 98% concordance, range 94%-100% with average of < 2 mm variation in the largest AVM [6-cm diameter]). The use of 3D models was associated with a 30-minute reduction in operative time (12%) in 2 cases when they were compared with matched controls as a feasibility study.CONCLUSIONS Patient-specific 3D printed models of pediatric cerebrovascular conditions can be constructed with high fidelity. This proof-of-principle series demonstrates, for the first time, confirmation of model accuracy using intraprocedural assessment and potential benefit through shortened operative time.