Skip to main content
SpringerLink
Log in

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

  • Research
  • Published:
Child's Nervous System Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Morgan MK, Davidson AS, Assaad NNA, Stoodley MA (2017) Critical review of brain AVM surgery, surgical results and natural history in 2017. Acta Neurochir 159:1457–1478

    Article  PubMed  Google Scholar 

  2. Gross BA, Storey A, Orbach DB et al (2015) Microsurgical treatment of arteriovenous malformations in pediatric patients: the Boston Children’s Hospital experience. J Neurosurg Pediatr 15:71–77

    Article  PubMed  Google Scholar 

  3. Johnson AB, Richter GT (2019) Surgical considerations in vascular malformations. Tech Vasc Interv Radiol 22:100635

    Article  PubMed  Google Scholar 

  4. de Oliveira E, Tedeschi H, Siqueira MG et al (1994) Anatomic principles of cerebrovascular surgery for arteriovenous malformations. Clin Neurosurg 41:364–380

    PubMed  Google Scholar 

  5. AlHamzah M, Hussain MA, Greco E et al (2022) Trends in operative case volumes of Canadian vascular surgery trainees. J Vasc Surg 75:687-694.e3

    Article  PubMed  Google Scholar 

  6. Park C-K (2022) 3D-printed disease models for neurosurgical planning, simulation, and training. J Korean Neurosurg Soc 65:489–498

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dong M, Chen G, Li J et al (2018) Three-dimensional brain arteriovenous malformation models for clinical use and resident training. Medicine 97:e9516

    Article  PubMed  PubMed Central  Google Scholar 

  8. Schlegel L, Ho M, Fields JM et al (2022) Standardizing evaluation of patient-specific 3D printed models in surgical planning: development of a cross-disciplinary survey tool for physician and trainee feedback. BMC Med Educ 22:614

    Article  PubMed  PubMed Central  Google Scholar 

  9. Thawani JP, Pisapia JM, Singh N et al (2016) Three-dimensional printed modeling of an arteriovenous malformation including blood flow. World Neurosurg 90:675-683.e2

    Article  PubMed  Google Scholar 

  10. Bae JW, Lee DY, Pang CH et al (2021) Clinical application of 3D virtual and printed models for cerebrovascular diseases. Clin Neurol Neurosurg 206:106719

    Article  PubMed  Google Scholar 

  11. Dong M, Chen G, Qin K, Ding X, Zhou D, Peng C, Zeng S, Deng X (2018) Development of three-dimensional brain arteriovenous malformation model for patient communication and young neurosurgeon education. Br J Neurosurg 32(6):646–649. https://doi.org/10.1080/02688697.2018.1424320. PMID: 29334259

    Article  PubMed  Google Scholar 

  12. Mashiko T, Otani K, Kawano R et al (2015) Development of three-dimensional hollow elastic model for cerebral aneurysm clipping simulation enabling rapid and low cost prototyping. World Neurosurg 83:351–361

    Article  PubMed  Google Scholar 

  13. Weinstock P, Prabhu SP, Flynn K et al (2015) Optimizing cerebrovascular surgical and endovascular procedures in children via personalized 3D printing. J Neurosurg Pediatr 16:584–589

    Article  PubMed  Google Scholar 

  14. Hak J-F, Boulouis G, Kerleroux B et al (2022) Pediatric brain arteriovenous malformation recurrence: a cohort study, systematic review and meta-analysis. J Neurointerv Surg 14:611–617

    PubMed  Google Scholar 

  15. Pepper J, Lamin S, Thomas A et al (2022) Clinical features and outcome in pediatric arteriovenous malformation: institutional multimodality treatment. Childs Nerv Syst. https://doi.org/10.1007/s00381-022-05800-4

    Article  PubMed  Google Scholar 

  16. Nikoubashman O, Di Rocco F, Davagnanam I et al (2015) Prospective hemorrhage rates of cerebral cavernous malformations in children and adolescents based on MRI appearance. AJNR Am J Neuroradiol 36:2177–2183

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Sattari SA, Yang W, Xu R et al (2022) Natural history and treatment of deep-seated brain arteriovenous malformations in pediatric patients. J Neurosurg Pediatr 30:578–585

    Article  PubMed  Google Scholar 

  18. Lv X, Jiang C, Wang J (2020) Pediatric intracranial arteriovenous shunts: advances in diagnosis and treatment. Eur J Paediatr Neurol 25:29–39

    Article  PubMed  Google Scholar 

  19. Hong S, Ogiwara H (2019) Long-term outcomes in pediatric unruptured brain arteriovenous malformation treated by nonconservative management: a single center analysis. Childs Nerv Syst 35:1363–1369

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK

    Amparo Saenz, Greg James & Adikarige Haritha Dulanka Silva

  2. Department of Craniofacial Engineering, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK

    Luke Smith

  3. Department of Neuroimaging, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK

    Kieran Seunarine

  4. Department of Interventional Neuroradiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK

    Adam Rennie

  5. Great Ormond Street Institute of Child Health, University College London, London, UK

    Greg James & Adikarige Haritha Dulanka Silva

Authors
  1. Amparo Saenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luke Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kieran Seunarine
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adam Rennie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fergus Robertson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Greg James
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Adikarige Haritha Dulanka Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LS wrote the methodology section about the 3D printing methods and helped with the figures related to that AS, DS and GJ wrote the article KS helped with the selection of the images and analysis of the MRI FR and AR helped with the angiographic figures and analysis of the postop images of the cases

Corresponding author

Correspondence to Amparo Saenz.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saenz, A., Smith, L., Seunarine, K. et al. 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). https://doi.org/10.1007/s00381-024-06421-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00381-024-06421-9

Keywords

Search

Navigation