It’s not every surgery patient who has a memento of the experience on their living room shelf.
But Nick Rahr said he’s more than happy to show visitors a 3D replica of his brain that surgeonsprinted out before his operation in February.
“Once they told me they were going to make this model, I said, could I have one? And they said sure,” said Rahr, who had a benign tumour called a meningioma removed from the rear quarter of his brain at the Halifax Infirmary.
While 3D digital brain scans have been used for years as a diagnostic and surgical guide tool, it was the first time that Nova Scotia surgeons have used a 3D mould of a patient’s brain.
“Seeing something on a screen and actually being able to handle it in your hands are two different things,” Dr. Simon Walling, head of neurosurgery at the QEII Health Sciences Centre, said in an interview with surgeon Dr. Adrienne Weeks on Tuesday.
“Yes, we work quite frequently with pictures on screens, but trying to position and figure out a clear corridor in a 3D model is very helpful.”
“Not everyone’s anatomy is the same,” Weeks said. “We know generally where everything is supposed to be . . . but every patient is slightly different. . . . Important structures vary from
person to person. . . . You might have a vein that’s slightly higher or slightly lower, those things make a big difference in surgery when you’re operating through very small corridors.”
While the surgical procedure itself obviously takes the most time — in Rahr’s case 16 hours — one of the most critical stages occurs before any incisions are made. The surgeons spend about an hour positioning the patient in order to gain the safest and most efficient route to the tumour.
“You can turn them like this or like this, and that changes the access you’re going to get with the microscope” that’s used to zoom in on the tumour, Weeks said. “That’s the main reason for the 3D printout, to use in the operating room to get the best angle.”
Weeks and Walling decided to go the 3D printing route in Rahr’s case because his tumour was deeply placed in a hard-to-access part of the brain. They had been mulling 3D physical models for a while because the cost of the technology has come down drastically since “additive manufacturing” was first developed in the 1980s.
“I’ve used some of the traditional approaches to this type of lesion and I’ve seen some of the adverse consequences,”
said Weeks, who has been a surgeon for 13 years, the past four in Halifax. “That’s why when I had this case and came to Dr. Walling saying, how else can I get this out? He had just gotten the 3D printer so Dr. Walling suggested we should print it and use this approach and it worked very well.”
The first indication something was amiss for Rahr occurred last spring when he began experiencing dizziness. He had a brain scan done but his doctor said it turned out clear.
But that November he came down with bacterial and viral infections and began experiencing severe head pain. His wife Judy was away so he said he dragged himself out of his Clayton Park home and got a taxi to the Halifax Infirmary emergency department.
That’s where things took a shocking turn: The ER physician asked him about the tumour they saw in the brain scans in his medical records.
“They said it’s not clear and you’ve got a tumour there and we’re going to do an MRI tonight just to see if there’s any change,” said Rahr, who dryly added that he’s since parted ways with his doctor.
After a referral from the ER team, he met with Weeks and Walling and he underwent surgery on Feb. 1.
They warned him it was possible he could experience speech or mobility problems but he said the side-effects amounted to some fatigue and headaches, which have abated. He has a followup appointment with the surgical team next week.
With this encouraging result, the surgeons plan to use 3D printing again. The changes in technology in general over his 30 years as a surgeon have been “mindblowing,” Walling said.
“I can remember coming to Halifax when there was only one MRI scanner for the entire Atlantic region.”
Weeks foresees the operating room of the not-so-distant future moving beyond 3D rendering into virtual reality.
“We’ll be able to project an image in front of us and manipulate it in 3D. And we may be able to hologram overlay your patient so you know exactly where it is on your patient. The technology is moving that quickly.”