Abstracts

Rationale: Approximately 30% of children with epilepsy will be refractory to medications and 10-30% of these individuals will undergo epilepsy surgery. Pre-surgical data are discussed with patients and caregivers in order to arrive at a decision to proceed with or defer surgery. Patients with medically intractable epilepsy and their caregivers have a poor understanding of the surgical procedures and potential complications (Zuccato et al., Epilepsia 2014;55:1754-1762). These misconceptions may contribute to delays in surgical care (Hrazdil et al., Epilepsy Behav EB. 2013;28(1):52-65). Three dimensional models of patient-specific anatomy have been utilized in cardiac disease (Biglino et al., BMJ Open. 2015;5(4):e007165) and renal tumors (Bernhard et al., World J Urol. 2016;34(3):337-345) to assist in medical decision making. We hypothesize patient-specific 3D brain models may also enhance patient and family education for epilepsy surgery. Methods: Functional and anatomic MRI examinations performed as part of routine clinical care were utilized to create 3D printed models utilizing the following approach:Virtual model creation: Segmentation of the skull, meninges and cortical gyri was performed using MIMICS^TM (Materialise, Belgium) 3D modeling software. Functional-anatomical regions of interest, including lesions, DTI fiber tracts and the venous vasculature were segmented using Dynasuite^TM (Invivo, USA), converted to DICOM format, and imported into MIMICS  to form a composite model of the brain comprising lesions, cortical anatomy, venous vasculature, and the sensorimotor tracts. Quality inspection was done by overlaying the contours of the 3D model on the 2D slice imaging data. The models were then exported as .stl files for 3D printing.3D Printing:The .stl files were imported into Geomagic Freeform(3D systems, SC, USA) in preparation for printing. To improve visualization, coronal split planes through select lesion were incorporated into the models, with provision for magnets along the plane to hold the model together yet allow for separation and inspection. Objet studio^TM software and CONNEX 3 Objet 350 polyjet printer (Stratasys, MN) with 30-micron resolution were used for printing. Material assignment was critical for visualization of the internal structures: brain-clear, lesion-opaque magenta, DTI fiber tracts-light opaque pink, and vasculature-clear magenta.Surveys were developed to assess patient/family opinion and physician opinion regarding the utility of the 3D printed model for patient education. Clinical information regarding patient age and developmental level, epilepsy type, etiology was gathered along with ratings of model utility and applicability utilizing a Likert scale of 1 (extremely unhelpful) to 8 (extremely helpful). Results: A total of six 3D printed brain models have been created utilizing the methods described above, with completed surveys completed for 3 at the time of abstract submission. All family members surveyed had a high school education or lower. All patients were candidates for lesionectomy for the treatment of intractable seizures. The tool rated highest in utility (mean score) for discussing epilepsy surgery was the 3D model (8), followed by verbal discussion (7), handouts (6.7) and brain MRI (6.3). Data continue to accrue, with updated analysis for presentation at the annual AES meeting in December, 2018. Conclusions: We describe a process for 3D modeling and printing of an integrated functional-anatomical brain model for patient and family counseling regarding epilepsy surgery. Preliminary data demonstrate perceived utility for patient-specific models. Further study is warranted to assess efficacy for reducing patient-related barriers for epilepsy surgery. Funding: None