Oct 14, 2016 | By Nick

3D printing has helped a surgeon prepare for one of the most complex surgical procedures there is: separating twins conjoined at the head.

It’s happening right now at the Montefiore hospital in New York, it’s a complicated procedure and yet the world of 3D printing and 3D scanning have given the boys a fighting chance.

Anias and Jadon McDonald are, scientifically speaking, a miracle. One out of every 2.5 million live births result in twins conjoined at the head. About 40% are stillborn, another third die within 24 hours and 80% of the children die before the age of two.

Now, at 13 months old, their parents have taken the gut-wrenching decision to separate them and risk both their lives. The surgery costs $2.5 million, it’s fraught with danger and yet 3D scanning and 3D printing has given the surgeon a much better chance.

Dr James Goodrich is arguably the finest craniopagus neurosurgeon in the world and he’s quantifiably the most experienced. This will be the seventh time he has separated twins and he has consulted on 13 other cases.

Now he has the advantage of 3D scanning to get a clear idea of what is happening and, in recent years, he has been able to produce a series of 3D models to help him plan the difficult surgical procedure.

“This is about as complicated as it gets,” Goodrich said, so he turned to 3D scanning and the models to help him visualize the surgery and plan every cut with meticulous detail.

The boys share between 1.5-2 inches of brain tissue and the procedure could take more than 20 hours. The level of complexity is simply mind-blowing and the risks of brain damage or death are significant with a procedure like this.

Without the opportunity to run through the process again and again on the screen and with the physical models, the boys’ chances of survival would be much lower. Conjoined twin surgery always hits the headlines, but there have been just 58 cranial conjoined twin separations since 1952.

Plastic surgeon Dr Oren Tepper is on hand to take over once Goodrich has managed the physical separation. He will reconstruct the boys’ skulls and the two surgeons have been planning and practicing for months with a mass of 3D scans and models.

“I have so many brains I don’t know what to do with them all,” Goodrich told CNN. The surgeons worked with 3D-Systems in Colorado to give them a complete picture of the surgery and a week before the operation the surgeons completed a virtual walkthrough of the entire process.

Well before the first cut, Goodrich was able to isolate the biggest problem area: a complex cluster of veins that both boys share. This is going to be the crucial stage of the surgical procedure.

"I know the vascular system we have to go through is complex," Goodrich says. "It's big. It's doable, but it's going to be tedious."

Tedious might not be the right word for cutting through an exceptionally complex mass of blood vessels that both boys are using, but at least Goodrich has been able to run through the procedure countless times in the planning stage. He has scans and models of the vessels, the surrounding area and the access points he needs.

"When you're doing a reconstruction like this, even when you're working on cranial-facial reconstruction, there's a lot of guessing," Goodrich says. “With the new technology, you're no longer guessing."

Four tissue expanders were mapped to their exact location in the boys’ new skulls. This was all done virtually and allowed the surgeons to see if they even had enough skin for the reconstructive surgery afterwards. It also helped them position the expanders in the best position, away from the incisions. This lessened the chance of infection and also gave Jadon and Anias the best possible chance when it came to the main separation surgery.

"None of that was ever possible before," Tepper says. "That's the first time that's ever been used."

There are so many firsts in this surgery that it’s hard to list them all, but medical models and 3D scans have once again played an invaluable part in preparing for an immensely complex operation. Now all the world can do is watch and wait as Goodrich and Tepper take months of study and planning into an arduous 20-hour long operation.

Much of the operation's $2.5 million cost was covered by insurance, but they are $100,000 short. Fortunately a GoFundMe page has also raised more than $124,000 to support the family. To donate, you can visit their GoFundMe page.

We wish the boys well and we know that 3D printing and scanning have given them the best possible chance for a happy life.



Posted in 3D Printing Application



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