Physicians at Boston Children’s Hospital report that four children with life-threatening cerebrovascular malformations posing surgical challenges have benefited from surgeons having 3D-printed models of their unique brain structures before undergoing high-risk brain procedures.

Fig. 1 – A 3D-printed arteriovenous malformation shown embedded in the surrounding brain tissue. Credit: Boston Children’s Hospital
The physicians used 3D printing and synthetic resins to create custom models of the children’s blood vessel malformations along with nearby normal blood vessels, as well as some of the surrounding brain anatomy. (See Figure 1)

“These children had unique anatomy with deep vessels that were very tricky to operate on,” said neurosurgeon Edward Smith, MD, co-director of the hospital’s Cerebrovascular Surgery and Interventions Center. He explained that the 3D-printed models allowed the surgeons to rehearse the cases beforehand to help reduce operative risk as much possible.

The four children ranged in age from 2 months to 16 years old. Three of them had arteriovenous malformations (AVMs), in which tangles of arteries and veins connect abnormally.

“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,” said Smith. “You can physically hold the 3D models, view them from different angles, practice the operation with real instruments, and get tactile feedback,” he explained.

The life-sized and enlarged 3D models were created in collaboration with the Boston Children’s Hospital Simulator Program 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 about 30 minutes. And, that translates to a relatively safer surgery since a 30-minute reduction is significant for children who are especially sensitive to anesthesia.

The surgeons say that they plan to continue using 3D models for their trickier cases. “3D printing has become a regular part of our process,” said 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.”

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