Three-dimensional printing and neuroendovascular simulation for the treatment of a pediatric intracranial aneurysm: case report

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The use of simulators has been described in a variety of fields as a training tool to gain technical skills through repeating and rehearsing procedures in a safe environment. In cerebrovascular surgery, simulation of skull base approaches has been used for decades. The use of simulation in neurointervention to acquire and enhance skills before treating a patient is a newer concept, but its utilization has been limited due to the lack of good models and deficient haptics. The advent of 3D printing technology and the development of new training models has changed this landscape. The prevalence of aneurysms in the pediatric population is much lower than in adults, and concepts and tools sometimes have to be adapted from one population to another. Neuroendovascular rehearsal is a valid strategy for the treatment of complex aneurysms, especially for the pediatric population. The authors present the case of an 8-year-old boy with a fusiform intracranial aneurysm and documented progressive growth, who was successfully treated after the authors rehearsed the placement of a flow diverter using a patient-specific 3D-printed replicator system model.

ABBREVIATIONS IA = intracranial aneurysm; ICA = internal carotid artery; MCA = middle cerebral artery.

Article Information

Correspondence Ricardo A. Hanel: Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, FL. rhanel@lyerlyneuro.com.

INCLUDE WHEN CITING Published online September 14, 2018; DOI: 10.3171/2018.6.PEDS17696.

S.S. and P.A.S. contributed equally to this work.

Disclosures Ricardo A. Hanel is a consultant for Medtronic, Cerenovus, Elum, Three Rivers Medical, Stryker, Codman, and MicroVention; owns stock in Elum, Three Rivers, Cerebrotech, EndoStream, Synchron, Blockade, Neurvana, and InNeuroCo; and serves on the scientific advisory board of Medina Medical.

© AANS, except where prohibited by US copyright law.

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Figures

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    A: Patient-specific replicator system model of the patient’s cerebral vasculature set up in the angiography suite. B and C: Angiographic oblique images of the silicone vessels after injecting contrast, depicting the fusiform aneurysm with a saccular component in the ICA. D and E: A Leo+ stent was deployed from the left MCA to the proximal segment of the ICA, and later, a SILK flow diverter was telescoped. The final construct did not properly expand (arrowhead) due to mismatch of the MCA-ICA and the sharp curvature of the MCA. F: 3D-printed silicone vessel demonstrating the sidewall aneurysm of the ICA (arrow) and the final construct kinking in the proximal segment of the MCA (arrowhead). Figure is available in color online only.

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    A–C: Cerebral angiogram, anteroposterior (A) and oblique views (B and C), demonstrating the sidewall aneurysm arising from the ICA. D: 3D reconstruction depicting the aneurysm in the left ICA and the previously coiled lesion in the contralateral side. Treatment was performed using the SILK device from the ICA terminus downward, covering the aneurysm neck. E–G: The SILK device partially deployed (E) and a fluoroscopic image (F) demonstrating the placement of the flow diverter (arrows). A final angiographic run demonstrated patency of the left ICA as well as its branches (G). H and I: A cone-beam CT scan was performed demonstrating good wall apposition of the device. J–L: At the 3-month follow-up, CT angiography was performed showing a stable location of the SILK device, no evidence of the aneurysm, and patency of the left ICA and its branches. M: At the 6-month imaging follow-up, MR angiography demonstrated complete occlusion of the left ICA aneurysm.

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