Joshi Devashish S, Stellon Michael A, Puricelli Michael D, Beninati Michael J, Garcia-Rodriguez Sylvana, Winchester Casey, Chapman Teresa, Lobeck Inna N
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Department of Surgery, Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Fetal Diagn Ther. 2025;52(2):172-177. doi: 10.1159/000541950. Epub 2024 Oct 10.
Prenatally diagnosed large fetal neck mass requires multidisciplinary consultation and evaluation of perinatal treatment options. The decision to perform ex utero intrapartum treatment (EXIT) is based on risk-benefit assessment for both the infant and mother. Though fetal ultrasound and MRI assist with operative planning, a three-dimensional anatomic model offers improved anatomic visualization and prenatal patient counseling.
Multiple surveillance ultrasound exams between gestational weeks 16 and 32 plus fetal MRI at 29/3 weeks were performed for fetal evaluation. A 3-dimensional model was printed (Form 3 and 3L, clear resin, Formlabs) incorporating fetal MRI (Ax SSFSE TE 100 DL and Cor SSFSE Brain DL) and using Mimics Medical and 3-matic Medical software (Materialise). A left fetal multicystic neck mass measuring 2.1 × 1.8 × 1.5 cm was diagnosed at 16/6 weeks gestation in a G8P2416. Fetal MRI performed at 29/3 weeks showed a large exophytic mixed solid-cystic cervicofacial mass, 10.3 × 9.4 × 10.6 cm arising from the left mandible, concerning for a teratoma. Prior to delivery, the model was used to educate and counsel the family regarding the complex clinical situation and the reasoning for delivery via EXIT followed by mass resection. Additionally, the model demonstrated tracheal narrowing and oropharyngeal compression, supporting airway intervention planning. The fetus was delivered at 32/3 weeks via EXIT to intubation using rigid bronchoscopy. Duration of time on placental support was 12 min. On day of life 5, the patient underwent resection of the cervical mass. Pathology revealed an immature teratoma, histologic grade 3 without yolk sac elements, and negative regional lymph nodes.
Three-dimensional fetal modeling facilitates perinatal airway needs assessment, patient counseling, delivery, and postnatal management.
产前诊断出的巨大胎儿颈部肿块需要多学科会诊并评估围产期治疗方案。决定实施产时宫外治疗（EXIT）基于对婴儿和母亲的风险效益评估。尽管胎儿超声和磁共振成像（MRI）有助于手术规划，但三维解剖模型能提供更好的解剖可视化效果并用于产前患者咨询。
在孕16至32⁺周期间进行了多次超声监测检查，并在孕29⁺³周进行了胎儿MRI检查以评估胎儿情况。使用Mimics Medical和3-matic Medical软件（Materialise公司），结合胎儿MRI（轴位单次激发快速自旋回波序列TE 100 DL和冠状位单次激发快速自旋回波序列脑成像DL），打印出一个三维模型（Form 3和3L，透明树脂，Formlabs公司）。在一名孕8产2⁺⁴⁺¹⁺⁶的孕妇孕16⁺⁶周时，诊断出左侧胎儿多囊性颈部肿块，大小为2.1×1.8×1.5厘米。孕29⁺³周时进行的胎儿MRI显示，一个巨大的外生性混合实性-囊性颈面部肿块，大小为10.3×9.4×10.6厘米，起源于左侧下颌骨，考虑为畸胎瘤。在分娩前，该模型用于向家属讲解和咨询复杂的临床情况以及通过EXIT分娩后进行肿块切除的理由。此外，该模型显示了气管狭窄和口咽受压情况，有助于气道干预规划。胎儿在孕32⁺³周时通过EXIT进行插管分娩，胎盘支持时间为12分钟。出生后第5天，患者接受了颈部肿块切除术。病理检查显示为未成熟畸胎瘤，组织学分级为3级，无卵黄囊成分，区域淋巴结阴性。
三维胎儿模型有助于围产期气道需求评估、患者咨询、分娩及产后管理。
