title: 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.
authors.affiliation: Department of Neurological Surgery, University of Messina.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Conti
authors.affiliation: Radiation Oncology, University of Messina.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pontoriero
authors.affiliation: Radiation Oncology, University of Messina.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Iatì
authors.affiliation: Department of Neurological Surgery, University of Messina.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marino
authors.affiliation: Department of Neurological Surgery, University of Messina.
authors.forename: Domenico
authors.initials: D
authors.lastname: La Torre
authors.affiliation: Neuroradiology, University of Messina.
authors.forename: Sergio
authors.initials: S
authors.lastname: Vinci
authors.affiliation: Department of Neurological Surgery, University of Messina.
authors.forename: Antonino
authors.initials: A
authors.lastname: Germanò
authors.affiliation: Radiation Oncology, University of Messina.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pergolizzi
authors.affiliation: Neurosurgery, University of Messina.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tomasello
keywords: 3d printing; Stereotactic Radiosurgery; arteriovenous malformation; frameless radiosurgery; vascular modeling