Three-dimensional model printing for surgery on arteriovenous malformations.

Abstract

Surgery for intracranial complex vascular malformations can be quite exigent and involves considerable preoperative planning. Here, we present the advantages of using three-dimensional (3D) printed models as a preoperative investigational modality. 3D printed models were made from thin-slice computed tomography (CT) angiography scans of 6 patients with arteriovenous malformations over an18-month period from August 2015 to December 2016. The locations of the arteriovenous malformations were in the Sylvian fissure in 1 patient, posterior frontal region in 2 patients, subfrontal region in 1 patient, and parietal region in 2 patients. The CT angiography was performed on a 64-slice CT scanner. Thin-slice axial CT sections were acquired and a volume file was created of the arteriovenous malformation and the required skull bones. The file was then transferred to the 3D printer for creating the model. The model depicted the precise nature of the compactness and location of the nidus in relationship to the skull. It was possible to clearly delineate the course, size, and number of feeding vessels and draining veins. The model made identification of the normal and abnormal vessels easier and assisted in the preparation and conduct of surgery. The model was made to scale and was placed beside the surgeon during the operation. The limitation of current technology was that the exact differentiation of arteries and veins by color coding was not possible. 3D printed models can be helpful in getting information regarding the architecture and character of the arteriovenous malformation. The models are cost-effective and easy to build.