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Saenz A, Smith L, Seunarine K, Rennie A, Robertson F, James G, Silva AHD. Implementation of 3D modelling to improve understanding and conceptualisation of arteriovenous malformation (AVM) morphology for the execution of safe microsurgical excision of complex paediatric AVMs. Childs Nerv Syst 2024; 40:2431-2442. [PMID: 38662221 DOI: 10.1007/s00381-024-06421-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Brain arteriovenous malformations (bAVMs) present complex challenges in neurosurgery, requiring precise pre-surgical planning. In this context, 3D printing technology has emerged as a promising tool to aid in understanding bAVM morphology and enhance surgical outcomes, particularly in pediatric patients. This study aims to assess the feasibility and effectiveness of using 3D AVM models in pediatric bAVM surgery. METHODOLOGY The study was conducted at Great Ormond Street Hospital, and cases were selected sequentially between October 2021 and February 2023. Eight pediatric bAVM cases with 3D models were compared to eight cases treated before the introduction of 3D printing models. The 3D modelling fidelity and clinical outcomes were assessed and compared between the two cohorts. RESULTS The study demonstrated excellent fidelity between 3D models and actual operative anatomy, with a median difference of only 0.31 mm. There was no statistically significant difference in angiographic cure rates or complications between the 3D model group and the non-3D model group. Surgical time showed a non-significant increase in cases involving 3D models. Furthermore, the 3D model cohort included higher-grade bAVMs, indicating increased surgical confidence. CONCLUSION This study demonstrates the feasibility and efficacy of utilizing 3D AVM models in pediatric bAVM surgery. The high fidelity between the models and actual operative anatomy suggests that 3D modelling can enhance pre-surgical planning and intraoperative guidance without significantly increasing surgical times or complications. Further research with larger cohorts is warranted to confirm and refine the application of 3D modelling in clinical practice.
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Affiliation(s)
- Amparo Saenz
- Department of Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
| | - Luke Smith
- Department of Craniofacial Engineering, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kieran Seunarine
- Department of Neuroimaging, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Adam Rennie
- Department of Interventional Neuroradiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | | | - Greg James
- Department of Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Adikarige Haritha Dulanka Silva
- Department of Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Cho HJ, Lloyd T, Zammit A, Pattavilakom Sadasivan A, Wagels M, Sutherland A. Radiologically derived 3D virtual models for neurosurgical planning. J Clin Neurosci 2024; 123:23-29. [PMID: 38518385 DOI: 10.1016/j.jocn.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 03/24/2024]
Abstract
Three dimensional (3D) virtual models for neurosurgery have demonstrated substantial clinical utility, especially for neuro-oncological cases. Computer-aided design (CAD) modelling of radiological images can provide realistic and high-quality 3D models which neurosurgeons may use pre-operatively for surgical planning. 3D virtual models are useful as they are the basis for other models that build off this design. 3D virtual models are quick to segment but can also be easily added to normal neurosurgical and radiological workflow without disruption. Three anatomically complex neuro-oncology cases that were referred from a single institution by three different neurosurgeons were segmented and 3D virtual models were created for pre-operative surgical planning. A face-to-face interview was performed with the surgeons after the models were delivered to gauge the usefulness of the model in pre-surgical planning. All three neurosurgeons found that the 3D virtual model was useful for presurgical planning. Specifically, the virtual model helped in planning operative positioning, understanding spatial relationship between lesion and surrounding critical anatomy and identifying anatomy that will be encountered intra-operatively in a sequential manner. It provided benefit in Multidisciplinary team (MDT) meetings and patient education for shared decision making.3D virtual models are beneficial for pre-surgical planning and patient education for shared decision making for neurosurgical neuro-oncology cases. We believe this could be further expanded to other surgical specialties. The integration of 3D virtual models into normal workflow as the initial step will provide an easier transition into modalities that build off the virtual models such as printed, virtual, augmented and mixed reality models.
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Affiliation(s)
- Hyun-Jae Cho
- Australian Centre for Complex Integration of Surgical Solutions (ACCISS), Woolloongabba, QLD 4102, Australia; Translational Research Institute, Woolloongabba, QLD 4102, Australia; The Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia.
| | - Thomas Lloyd
- Australian Centre for Complex Integration of Surgical Solutions (ACCISS), Woolloongabba, QLD 4102, Australia; Translational Research Institute, Woolloongabba, QLD 4102, Australia; The Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia; Department of Radiology, The Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - Adrian Zammit
- The Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia; Department of Neurosurgery, The Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - Ananthababu Pattavilakom Sadasivan
- The Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia; Department of Neurosurgery, The Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - Michael Wagels
- Australian Centre for Complex Integration of Surgical Solutions (ACCISS), Woolloongabba, QLD 4102, Australia; Translational Research Institute, Woolloongabba, QLD 4102, Australia; The Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - Allison Sutherland
- Australian Centre for Complex Integration of Surgical Solutions (ACCISS), Woolloongabba, QLD 4102, Australia; Translational Research Institute, Woolloongabba, QLD 4102, Australia; The Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
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Jackson E, Markovic LE, Perlini M. Comparison of two-dimensional imaging to three-dimensional modeling of intrahepatic portosystemic shunts using computed tomography angiography. Vet Radiol Ultrasound 2024; 65:130-137. [PMID: 38279771 DOI: 10.1111/vru.13337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/28/2023] [Accepted: 12/28/2023] [Indexed: 01/28/2024] Open
Abstract
Computed tomography angiography (CTA) is used for the diagnosis of intrahepatic portosystemic shunts (IHPSS). When planning for transcatheter intervention, caudal vena cava (CVC) measurements are typically obtained from two-dimensional (2D) imaging to aid in stent selection. We hypothesized that clinically applicable three-dimensional (3D) IHPSS models can be generated, and CVC measurements will not differ between 2D images and 3D models. Computed tomography angiography datasets from client-owned dogs with IHPSS at the University of Georgia Veterinary Teaching Hospital from 2016 to 2022 were analyzed. Materialise Mimics 25.0 and 3-matic 17.0 were used for 3D modeling. Caudal vena cava diameters were measured in 2D dorsal and transverse planes 20 mm cranial and caudal from the shunt ostium and were compared with CVC diameters from 3D models. Length was measured in the 2D dorsal plane between midpoints of each diameter and compared to the 3D model length. Data are presented as mean (SD), and intraclass correlation coefficients were performed. Three-dimensional models were generated for 32 IHPSS (15 right-, 12 left-, and five central-divisional). Two-dimensional dorsal and transverse area-associated diameter measurements were 16.7 mm (5.6) and 15.5 mm (4.2) cranial; 14.9 mm (4.2) and 14.3 mm (3.7) caudal. Three-dimensional area-associated diameter measurements were 15.3 mm (4.4) cranial and 14.0 mm (3.6) caudal. The 2D length was 61.5 mm (7.1) compared with 3D 59.9 mm (7.2). Intraclass correlation coefficients comparing 2D and 3D diameters were all >0.80, indicating very good agreement, with good agreement (>0.60) for length. Clinically applicable 3D IHPSS models can be generated using engineering software. Measurements from 3D models are consistent with 2D planar imaging. Both 2D CTA and 3D virtual models can be utilized for preprocedural planning, depending on clinician preference.
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Affiliation(s)
- Erin Jackson
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Lauren E Markovic
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Michael Perlini
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
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Park CK. 3D-Printed Disease Models for Neurosurgical Planning, Simulation, and Training. J Korean Neurosurg Soc 2022; 65:489-498. [PMID: 35762226 PMCID: PMC9271812 DOI: 10.3340/jkns.2021.0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/17/2021] [Indexed: 11/27/2022] Open
Abstract
Spatial insight into intracranial pathology and structure is important for neurosurgeons to perform safe and successful surgeries. Three-dimensional (3D) printing technology in the medical field has made it possible to produce intuitive models that can help with spatial perception. Recent advances in 3D-printed disease models have removed barriers to entering the clinical field and medical market, such as precision and texture reality, speed of production, and cost. The 3D-printed disease model is now ready to be actively applied to daily clinical practice in neurosurgical planning, simulation, and training. In this review, the development of 3D-printed neurosurgical disease models and their application are summarized and discussed.
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Affiliation(s)
- Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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