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Case 1. (
A
) Coronal MRI section showing both kidneys affected by Wilms tumor, confirming the large size of the left tumor mass. (
B
and
C
) Volumetric reconstructions of both tumors. Healthy renal parenchyma susceptible to nephron sparing surgery was proved. LK, left kidney; MRI, magnetic resonance imaging; RK, right kidney.
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The volumetric reconstruction ( Fig. 2 ) of both the tumor and the healthy renal tissue proved that the left kidney parenchyma free of nephroblastoma was greater than the bidimensional imaging tests showed, considering feasible to perform bilateral nephron-sparing surgery.
Case 1. The images (
A
-
C
) show different moments of the surgical intervention. After bilateral nephron-sparing surgery, coagulation was performed with adhesive matrix and plication of the renal parenchyma. In the image (
D
), the resected specimens are shown together with their corresponding three-dimensional models, objectifying the great similarity between both.
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The 3D physical models were consulted during the procedure due to doubts regarding the vascularization of both tumors ( Fig. 3 ).
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Case 2. (
A
) Three-dimensional reconstruction performed from the preoperative CT. There are three metastases in the right lung and one in the left one. (
B
and
C
) Cross-sections of the thoracic CT. Lesions marked by arrow correspond to those marked with the same color in the virtual reconstruction. CT, computed tomography.
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Fig. 4 shows the reconstruction of the metastatic lesions and the comparison with their location in the CT scan.
Case 3. (
A
) MRI showing a large abdominal mass that moves the liver upward. (
B
) Virtual reconstruction of the tumor (yellow), liver (green), both kidneys (gray), and spleen (brown). The involved vasculature was also reconstructed (aorta in red, vena cava in blue, and portal vein in purple). (
C
) Modified virtual reconstruction, observing the tumor of semitransparent consistency, which allows the visualization of the renal artery and vein within the tumor. The kidney is displaced inferiorly with loss of its morphology due to the mass effect. MRI, magnetic resonance imaging.
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Fig. 5 shows an axial section of the MRI showing the large size of the neuroblastoma and the correspondence with the virtual reconstruction in which it is clearly visualized how the tumor includes the superior mesenteric artery and the renal artery, making possible to know the disfigured anatomy by the large abdominal mass.
Case 3. (
A
) Different printed models representing the abdominal neuroblastoma. The superior model includes tumor (yellow), aorta (red) and vena cava (blue) with its respective branches, liver (blue), both kidneys (green), and spleen (brown). The different structures are assembled by a magnetization system. The other two models represent the tumor and the relevant vascularity in different textures. (
B
) The model was consulted several times during the surgery. In the image, the correspondence between the model and the surgical anatomy is observed.
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In addition to planning the surgical approach, these models were also consulted several times as a guide during the intervention ( Fig. 6 ).
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Case 4. Virtual reconstruction of cervicothoracic paravertebral ganglioneuroma and comparison with images obtained by MRI (A-B coronal view, C-D transverse view). The tumor displaces the left carotid artery, the internal jugular vein, and the airway. The vertebral artery is encased by the tumor. MRI, magnetic resonance imaging.
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Fig. 7 shows the comparison between MRI and virtual reconstruction.