AMS Spring 2023

3D Printed Fetal Models Prep Surgeons for In-Utero Spina Bifida Procedure

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Spina bifida is a birth defect that happens when the unborn baby’s spinal cord doesn’t close normally during development, which then causes defects in the spinal cord and spine bones. According to the Mayo Clinic, depending on the type of defect, its size and location, and any complications, the defect can range from mild to severe, and can cause a laundry lists of neurological disabilities, including the inability to walk. Sometimes early treatment can require in-utero surgery to correct the defect on babies who are still developing inside their mother’s womb, but obviously it’s tricky to operate on both a mother and her unborn child at the same time.

3D printing has been used to help make these surgeries safer and easier, often through the use of anatomical models, and that’s just what the Orlando Health Winnie Palmer Hospital for Women & Babies is doing now.

Orlando Health works with Digital Anatomy Simulations for Healthcare, LLC (DASH) to enhance and use MRI and ultrasound imaging, as well as 3D printing, to create detailed models so surgeons can plan out these procedures and determine any possible obstacles ahead of time, which helps lower the overall surgical risks when repairing spina bifida.

Jack Stubbs, president and CEO of DASH, prepares a 3D model of a fetus using MRI and ultrasound imaging. The printed model will give Orlando Health surgeons a life-size representation they can use to prepare for in-utero spina bifida surgery.

DASH President and CEO Jack Stubbs said, “The fetal models not only help surgeons plan for things like where to make an incision and how to repair the defect, but also helps reduce the duration of the surgery to limit the developing baby’s exposure.

“We are able to create models that are extremely realistic by using a stack of two-dimensional images taken throughout the pregnancy and enhancing them to reconstruct a better visualization of what the fetus truly looks like.”

These 3D printed models are being used in the hospital’s open fetal surgery program. Orlando Health is the only facility in Florida, and in fact one of only 12 facilities in the country, that can perform this kind of complex in-utero spina bifida surgery.

“The 3D reconstruction of the fetus can really educate the surgeon on the real-life shape, size and location of the spinal lesion, as well as prepare the surgeon to have the appropriate equipment ready to treat this condition surgically,” explained Samer Elbabaa, MD, Medical Director, Pediatric Neurosurgery, Orlando Health Arnold Palmer Hospital for Children. “It’s a level of detail that we are not able to see in traditional imaging, but that is extremely valuable in these cases where we cannot actually see the defect ahead of surgery.”

Samer Elbabaa, MD, a pediatric neurosurgeon at Orlando Health Arnold Palmer Hospital for Children, shows expecting parents Jocelyn and Jared Rodriguez a 3D printed model of their developing baby.

Together, DASH and Orlando Health are 3D printing lifelike, high-resolution models, with multiple materials and colors, of these developing babies. Because they’re able to see anatomical details like nerve and vascular anatomy, skeletal structure, and fluid sacs in the brain and spine caused by spina bifida, surgeons are better able to prepare for these extremely delicate surgeries.

“We are able to show details such as the skeletal structure, nerve and vascular anatomy and the exact shape, size and location of the spinal lesion. This not only helps surgeons plan for things like where to make an incision and how to repair the defect, but also helps reduce the duration of the surgery to limit the developing baby’s exposure,” Stubbs said.

Jocelyn and Jared Rodriguez look at an ultrasound of their baby at Orlando Health Winnie Palmer Hospital for Women & Babies. Orlando Health surgeons used this imaging to create a 3D printed replica of the baby to prepare for a complicated procedure to treat the baby’s spina bifida in utero.

Not only do these detailed 3D printed models help surgeons plan for the procedure, they also give them a valuable tool to explain the developing baby’s condition to parents, like the Rodriguezes, who are expecting their first child.

“At first, we just thought it was a model showing the same kind of condition that our baby was diagnosed with, but then Dr. Elbabaa told us that it was made using the 20-week MRI of our daughter. We could see the brain and the spine and I looked down at it and thought, ‘I’m holding my daughter right now? That’s pretty awesome,'” said Jared Rodriguez.

Seeing the 3D printed model gave them a better idea of how the surgeons will treat their daughter’s spina bifida, and gave them more confidence going into the surgery, which will ultimately give their baby a better future.

Jocelyn Rodriguez said, “Every appointment we go to, we just keep getting more good news and she’s already showing how strong she is. We know that this surgery will give her the best shot at a normal lifestyle and we’re excited to see the positive results as she grows.”

Dr. Samer Elbabaa holds 3D printed models of fetuses.

Surgeons, like Dr. Elbabaa, are definitely getting successful results from these fetal spina bifida surgeries, as most, though not all, of the babies who’ve had this in-utero procedure have better functionality and fewer health concerns than those who undergo the surgery after they’re born. Orlando Health experts hope that in the future, they can work with DASH to grow the program and 3D print models for other types of birth defects that can be treated in-utero.

“The 3D-printed fetal models not only mimic the anatomy of the spinal defect, but also educate the surgeon about potential challenges or complications. Having this extremely accurate 3D model allows us to see much more than traditional imaging and ensures the procedure is done as safely and effectively as possible,” Dr. Elbabaa concluded.

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