Division of Anesthesiology, Intensive Care, and Pain Medicine, Tel-Aviv Medical Center, affiliated with the Sackler Faculty of Medicine, 6 Weizmann Street, 6423906, Tel-Aviv, Israel.
Department of Radiology, Tel-Aviv Medical Center, The Dana-Dwek Children's Hospital, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
J Anesth. 2021 Aug;35(4):595-598. doi: 10.1007/s00540-021-02950-8. Epub 2021 Jun 1.
Recent technological developments in three-dimensional (3D) printing have created new opportunities for applications in clinical medicine. 3D printing has been adopted for teaching and planning complicated surgeries, including maxillofacial, orthopedic reconstructions, and airway manipulation for one-lung ventilation or airway stenting. We present here the first use of such technology to print a model from in utero imaging for intrapartum treatment planning. A 32-week fetus presented with congenital high airway obstruction syndrome (CHAOS) due to a large cervical lymphatic malformation. An ex utero intrapartum treatment (EXIT) procedure was planned to allow delivery of a viable infant. We printed a 3D model of the fetal airway by printing separate elements: mandible, tongue, mass, larynx, and trachea from the fetal MRI. The elements were stuck together maintaining correct anatomical relationships. Airway planning was then performed in consultation with a pediatric ear nose and throat (ENT) surgeon. 3D modeling in utero presents many challenges: the resolution of the 3D model generated from a fetal MRI is less crisp than from CT images, fetal position may be variable and not in a defined anatomical plane, movement artifact occurs. Nevertheless, pre-procedure simulations with the aid of 3D modeling promoted team cooperation and well-prepared management of the fetus during EXIT.
近年来，三维（3D）打印技术的发展为临床医学的应用创造了新的机会。3D 打印已被用于教学和规划复杂手术，包括颌面、骨科重建以及单肺通气或气道支架的气道操作。我们在此介绍了首次使用这种技术打印宫内成像模型以进行产时治疗计划。一名 32 周的胎儿因颈部巨大淋巴管畸形而患有先天性高位气道阻塞综合征（CHAOS）。计划进行宫外产时治疗（EXIT）程序，以确保分娩出一个有活力的婴儿。我们通过打印胎儿 MRI 的单独元素（下颌骨、舌头、肿块、喉部和气管）来打印胎儿气道的 3D 模型。这些元素粘在一起，保持正确的解剖关系。然后与儿科耳鼻喉科（ENT）外科医生一起进行气道规划。宫内 3D 建模存在许多挑战：从胎儿 MRI 生成的 3D 模型的分辨率不如 CT 图像清晰，胎儿的位置可能会变化，并且不在定义的解剖平面上，还会出现运动伪影。然而，借助 3D 建模进行术前模拟促进了团队合作，并为 EXIT 期间胎儿的管理做好了充分准备。
