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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.



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Original article
peer-reviewed

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


Author Information

Alfredo Conti Corresponding Author

Department of Neurological Surgery, University of Messina

Antonio Pontoriero

Radiation Oncology, University of Messina

Giuseppe Iatì

Radiation Oncology, University of Messina

Daniele Marino

Department of Neurological Surgery, University of Messina

Domenico La Torre

Department of Neurological Surgery, University of Messina

Sergio Vinci

Neuroradiology, University of Messina

Antonino Germanò

Department of Neurological Surgery, University of Messina

Stefano Pergolizzi

Radiation Oncology, University of Messina

Francesco Tomasello

Department of Neurological Surgery, University of Messina


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

Acknowledgements

We are very grateful to C. Fiumicello and its Si3D printing company for the efforts made to prototype complex 3D models.


Original article
peer-reviewed

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


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Original article
peer-reviewed
1 Place Winner

Frameless Stereotactic Radiosurgery

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

  • Author Information
    Alfredo Conti Corresponding Author

    Department of Neurological Surgery, University of Messina

    Antonio Pontoriero

    Radiation Oncology, University of Messina

    Giuseppe Iatì

    Radiation Oncology, University of Messina

    Daniele Marino

    Department of Neurological Surgery, University of Messina

    Domenico La Torre

    Department of Neurological Surgery, University of Messina

    Sergio Vinci

    Neuroradiology, University of Messina

    Antonino Germanò

    Department of Neurological Surgery, University of Messina

    Stefano Pergolizzi

    Radiation Oncology, University of Messina

    Francesco Tomasello

    Department of Neurological Surgery, University of Messina


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements

    We are very grateful to C. Fiumicello and its Si3D printing company for the efforts made to prototype complex 3D models.


    Article Information

    Published: April 29, 2016

    DOI

    10.7759/cureus.594

    Cite this article as:

    Conti A, Pontoriero A, Iatì G, et al. (April 29, 2016) 3D-Printing of Arteriovenous Malformations for Radiosurgical Treatment: Pushing Anatomy Understanding to Real Boundaries. Cureus 8(4): e594. doi:10.7759/cureus.594

    Publication history

    Received by Cureus: April 05, 2016
    Peer review began: April 06, 2016
    Peer review concluded: April 22, 2016
    Published: April 29, 2016

    Copyright

    © Copyright 2016
    Conti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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.



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Alfredo Conti, Associate Professor, M.D., Ph.D.

Department of Neurological Surgery, University of Messina

For correspondence:
alfredo.conti@unime.it

Antonio Pontoriero

Radiation Oncology, University of Messina

Giuseppe Iatì

Radiation Oncology, University of Messina

Daniele Marino

Department of Neurological Surgery, University of Messina

Domenico La Torre

Department of Neurological Surgery, University of Messina

Sergio Vinci

Neuroradiology, University of Messina

Antonino Germanò

Department of Neurological Surgery, University of Messina

Stefano Pergolizzi

Radiation Oncology, University of Messina

Francesco Tomasello

Department of Neurological Surgery, University of Messina

Alfredo Conti, Associate Professor, M.D., Ph.D.

Department of Neurological Surgery, University of Messina

For correspondence:
alfredo.conti@unime.it

Antonio Pontoriero

Radiation Oncology, University of Messina

Giuseppe Iatì

Radiation Oncology, University of Messina

Daniele Marino

Department of Neurological Surgery, University of Messina

Domenico La Torre

Department of Neurological Surgery, University of Messina

Sergio Vinci

Neuroradiology, University of Messina

Antonino Germanò

Department of Neurological Surgery, University of Messina

Stefano Pergolizzi

Radiation Oncology, University of Messina

Francesco Tomasello

Department of Neurological Surgery, University of Messina