3D-Printing of Arteriovenous Malformations for Radiosurgical Treatment: Pushing Anatomy Understanding to Real Boundaries

Abstract

Radiosurgery of arteriovenous malformations (AVMs) is a challenging procedure. Accuracy of target volume contouring is one major issue to achieve AVM obliteration while avoiding disastrous complications due to suboptimal treatment. We describe a technique to improve the understanding of the complex AVM angioarchitecture by 3D prototyping of individual lesions.Arteriovenous malformations of ten patients were prototyped by 3D printing using 3D rotational angiography (3DRA) as a template. A target volume was obtained using the 3DRA; a second volume was obtained, without awareness of the first volume, using 3DRA and the 3D-printed model. The two volumes were superimposed and the conjoint and disjoint volumes were measured. We also calculated the time needed to perform contouring and assessed the confidence of the surgeons in the definition of the target volumes using a six-point scale.The time required for the contouring of the target lesion was shorter when the surgeons used the 3D-printed model of the AVM (p=0.001). The average volume contoured without the 3D model was 5.6 ± 3 mL whereas it was 5.2 ± 2.9 mL with the 3D-printed model (p=0.003). The 3D prototypes proved to be spatially reliable. Surgeons were absolutely confident or very confident in all cases that the volume contoured using the 3D-printed model was plausible and corresponded to the real boundaries of the lesion. The total cost for each case was 50 euros whereas the cost of the 3D printer was 1600 euros.3D prototyping of AVMs is a simple, affordable, and spatially reliable procedure that can be beneficial for radiosurgery treatment planning. According to our preliminary data, individual prototyping of the brain circulation provides an intuitive comprehension of the 3D anatomy of the lesion that can be rapidly and reliably translated into the target volume.

A small 3D-printing model of macroadenomas for endoscopic endonasal surgery

“…As it is highly precise and allows personalization, 3D-printing technology has started to be applied in medicine in recent years [ 16 , 17 ]. In neurosurgery, 3D-printing technology can provide models for the patients’ disease characteristics, such as skull defects [ 18 ], brain tumors [ 19 ], intracranial aneurysms [ 20 ], and intracranial vascular malformations [ 21 ]. 3D-printing technology provides tools that aid in the resection of tumors, such as positioning models for the resection of tumors in brain functional regions [ 22 ] and navigation models for spinal surgery [ 23 , 24 ].…”

3D Printing is a Transformative Technology in Congenital Heart Disease

“…Another arena where 3D printing can bring about transformative change is in the education and training of the next generation of physicians. This is an established practice in neurosurgery 73 , 74 and otolaryngology (17) , with more recent application in cardiology 75 , 76 , 77 , 78 . Although medical training has long followed the practice of “see 1, do 1, teach 1,” use of 3D models in education represents a paradigm shift from an apprenticeship model to a simulator-based learning method that complements traditional mentored training 79 , 80 .…”

“…As a tool for surgical simulation, 3D printing has been applied toward septal myectomy for hypertrophic obstructive cardiomyopathy (70) , vascular procedures 76 , 77 , 81 , and complex congenital procedures, as described by Yoo et al. (72) ( Figure 15 ).…”

Application of Time-Resolved 3D Digital Subtraction Angiography to Plan Cerebral Arteriovenous Malformation Radiosurgery

“…The contoured volumes of both 4D-DSA and integrated stereotactic imaging were exported to Matlab R2013b (MathWorks), and volume analysis was performed. 21,22 Conjoint and disjoint volumes between 4D-DSA and integrated stereotactic imaging were measured. The results are summarized in the Table. The Wilcoxon signed rank test and the Wilcoxon rank sum test were used to evaluate registration errors and contoured volumes of stereotactic 4D-DSA and that of the integrated stereotactic imaging.…”