Utility of 3-Dimensional Modeling in Prenatally Diagnosed Large Fetal Neck Mass.

IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Fetal Diagnosis and Therapy Pub Date : 2024-10-10 DOI:10.1159/000541950
Devashish S Joshi, Michael A Stellon, Michael D Puricelli, Michael J Beninati, Sylvana Garcia-Rodriguez, Casey Winchester, Teresa Chapman, Inna N Lobeck
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Abstract

Introduction: Prenatally diagnosed large fetal neck mass requires multidisciplinary consultation and evaluation of perinatal treatment options. The decision to perform ex utero intrapartum treatment (EXIT) is based on risk-benefit assessment for both the infant and mother. Though fetal ultrasound and MRI assist with operative planning, a three-dimensional anatomic model offers improved anatomic visualization and prenatal patient counseling.

Case presentation: Multiple surveillance ultrasound exams between gestational weeks 16 and 32 plus fetal MRI at 29/3 weeks were performed for fetal evaluation. A 3-dimensional model was printed (Form 3 and 3L, clear resin, Formlabs) incorporating fetal MRI (Ax SSFSE TE 100 DL and Cor SSFSE Brain DL) and using Mimics Medical and 3-matic Medical software (Materialise). A left fetal multicystic neck mass measuring 2.1 × 1.8 × 1.5 cm was diagnosed at 16/6 weeks gestation in a G8P2416. Fetal MRI performed at 29/3 weeks showed a large exophytic mixed solid-cystic cervicofacial mass, 10.3 × 9.4 × 10.6 cm arising from the left mandible, concerning for a teratoma. Prior to delivery, the model was used to educate and counsel the family regarding the complex clinical situation and the reasoning for delivery via EXIT followed by mass resection. Additionally, the model demonstrated tracheal narrowing and oropharyngeal compression, supporting airway intervention planning. The fetus was delivered at 32/3 weeks via EXIT to intubation using rigid bronchoscopy. Duration of time on placental support was 12 min. On day of life 5, the patient underwent resection of the cervical mass. Pathology revealed an immature teratoma, histologic grade 3 without yolk sac elements, and negative regional lymph nodes.

Conclusion: Three-dimensional fetal modeling facilitates perinatal airway needs assessment, patient counseling, delivery, and postnatal management.

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三维建模在产前诊断胎儿颈部巨大肿块中的应用。
导言:产前确诊胎儿颈部巨大肿块需要多学科会诊,并评估围产期治疗方案。产前治疗(EXIT)的决定基于对婴儿和母亲的风险效益评估。虽然胎儿超声和核磁共振成像有助于手术规划,但三维解剖模型可提供更好的解剖可视化和产前患者咨询:病例介绍:在孕 16 至 32 周期间进行了多次超声监测检查,并在孕 29/3 周时进行了胎儿核磁共振成像,以评估胎儿情况。结合胎儿核磁共振成像(Ax SSFSE TE 100 DL 和 Cor SSFSE Brain DL)并使用 Mimics Medical 和 3-matic Medical 软件(Materialise)打印了一个三维模型(Form 3 和 3L,透明树脂,Formlabs)。一名 G8P2416 孕妇在妊娠 16/6 周时被诊断出左侧胎儿多囊性颈部肿块,大小为 2.1x1.8x1.5 厘米。29/3周时进行的胎儿核磁共振成像(MRI)显示,一个巨大的外生混合实性囊性颈面部肿块(10.3 x 9.4 x 10.6 cm)从左下颌骨处长出,疑似畸胎瘤。在分娩前,该模型用于教育和指导家属,让他们了解复杂的临床情况,以及通过 EXIT 分娩并切除肿块的理由。此外,模型还显示了气管狭窄和口咽受压的情况,为气道干预计划提供了支持。胎儿在 32/3 周时通过 EXIT 顺产,并使用硬质支气管镜进行了插管。胎盘支持时间为 12 分钟。在生命的第 5 天,患者接受了宫颈肿块切除术。病理结果显示为未成熟畸胎瘤,组织学 3 级,无卵黄囊成分,区域淋巴结阴性:三维胎儿建模有助于围产期气道需求评估、患者咨询、分娩和产后管理。
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来源期刊
Fetal Diagnosis and Therapy
Fetal Diagnosis and Therapy 医学-妇产科学
CiteScore
4.70
自引率
9.10%
发文量
48
审稿时长
6-12 weeks
期刊介绍: The first journal to focus on the fetus as a patient, ''Fetal Diagnosis and Therapy'' provides a wide range of biomedical specialists with a single source of reports encompassing the common discipline of fetal medicine.
期刊最新文献
Added value in low-risk pregnancies of longitudinal changes in uterine Doppler and circulating angiogenic factors during the third trimester in predicting term preeclampsia. Sequence of events leading to medical abortion for fetal indications after 34 weeks' gestation: 23 years of experience in a single medical center. Postnatal outcomes of fetal variants of unknown significance in prenatal CMA: A single-center study. Fetal Hypoplastic Left Heart Syndrome with Intact Atrial Septum: From successful in-utero stenting to subtotal stent-occlusion - a case report. Utility of 3-Dimensional Modeling in Prenatally Diagnosed Large Fetal Neck Mass.
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