Ever the pioneer, Penn Vet is venturing into new frontiers, exploring dimensions of medicine once only imagined. Led by its Neurology and Neurosurgery service, this foray into the future began a few years ago, when Dr. Evelyn Galban, Clinical Assistant Professor of Neurology and Neurosurgery, turned to 3D printing for help in a complex case.

An Innovative Effort

A 3D-printed model of a dog's skull used to plan a complicated surgery ahead of time.At the time, Galban and her team were assessing Millie, an eight-month-old canine patient with a large mass on her skull. “We were looking at Millie’s CT scans and trying to clearly understand what surgery would involve—what areas would be affected and how serious it would be,” said Galban. “These questions are hard to answer with two dimensional images. So we started thinking about solutions that would let us hold Millie’s skull and look at it from all angles. That’s when we came up with the idea of printing a 3D replica of the skull, mass and all.”

Neurology resident Dr. Jonathan Wood researched the availability of 3D printers across the University, finding one in PennDesign’s Fabrication Lab. Galban contacted the lab for what would be the beginning of a successful inter-University collaboration to help animal patients—and to transform veterinary neurology and neurosurgery.

Working with Millie’s CT scans, the Fabrication Lab printed a perfectly precise model of her skull, made from a gypsum powder that’s bound by acrylic and sealed with a cyanoacrylate, an industrial-grade adhesive. Having this clone enabled Galban, Wood, and the rest of Millie’s veterinary team to gain a deeper understanding of the mass’ placement and to practice their surgical approach before the pup’s operation.

Ultimately, Millie did not end up on Penn Vet’s operating table. But Galban and her team were hooked on 3D printing. In partnership with the Fabrication Lab, they have used the technology to replicate injuries and disease in other animals, including a cat and a goat. And, earlier this year, they successfully completed a complicated procedure on a dog that likely would not have been possible without a 3D model.

Eager to create a collaborative global forum where veterinarians and students can share 3D models of real cases, Galban teamed up with the National Institutes of Health’s 3D Print Exchange—a web-based portal of printable models related to biomedical science. Over time, she aims to build Penn Vet’s collection on the Print Exchange into the world’s largest library of 3D animal models for veterinary practitioners everywhere to print, study, discuss, and consult.

Smart Neuro

Dr. Jonathan Wood consults with radiologist Dr. Jonathan Nevins (foreground) about a 3D rendering of a CT image.Although Penn Vet’s bold journey into multi-dimensional medicine is in its earliest stages, Galban has big plans for applying 3D technologies to neurology and neurosurgery. She is calling the School’s 3D medicine program SMART Neuro—simulate, model, animate, reconstruct, transform. Currently, SMART Neuro offers the 3D Print Exchange library and 3D printing. Looking forward, Galban envisions it will one day include virtual reality and holography, both of which permit interactive simulations of individual surgeries with room for trial and error that’s not available on live patients.

Explained Galban, “I’m extremely interested in how virtual reality tools can give students deeper insight into real surgical cases and faculty dynamic methods of educating and engaging tactile learners.”

Pushing SMART Neuro’s boundaries even further is the ultimate in futuristic medicine: holography. At a recent conference, Galban had the opportunity to interact with a holographic heart.

“The hologram projected from a tablet in three dimensions,” she said. “Wearing special glasses and holding a special pen, I was able to rotate the heart in any direction, make it beat, add blood to it, and dissect it. I am excited to explore bringing holography to the School.”

Even though a fully realized SMART Neuro program still remains on the horizon for Penn Vet—more research is needed to identify what it would take to acquire the necessary equipment—Galban believes 3D medicine holds limitless possibilities for teaching, learning, and research.

“These innovations can really open up what we, as surgeons, educators, and researchers, are able to do,” she said. “They will not only make us more confident going into risky procedures, but will help everyone involved, from families to students to clinical staff, understand what’s going to happen before we even start working on the patient. The implications for education and advancing quality of care are truly boundary-breaking. And research applications for 3D medicine are limited only by the questions asked.”

In Clubber’s Case, A World of Difference

Clubber poses after surgery with the two models of his skullSeven-year-old Clubber came to Penn Vet in late 2015 for treatment of a fibro-osseous proliferation between his eyes that extended to his brain. Penn Vet advised surgery, and the dog’s owners opted in.

It was a risky and complicated procedure that would require removing a large portion of the skull. So Penn Vet called in a new partner to help in the case—PennDesign’s Fabrication Lab.

Using files provided by Penn Vet, the lab printed a 3D model of Clubber’s diseased skull. Ahead of Clubber’s surgery, resident Jonathan Wood carved into the bone-like replica, creating an operating road map. Wood also used the model to mold a titanium mesh panel to replace the excised portion of the dog’s skull and protect his brain.

On operating day in January, Clubber’s surgical team removed a piece of his cranium, frontal sinus, and the orbits, referencing the 3D model for intra-operative guidance. “Having the model made a world of difference for us,” said Wood. “If we didn’t have the option to practice on the skull, I probably would not have recommended such an extensive surgery.”

After a seamless recovery, today Clubber is his regular self—happy, healthy, and eager to play. He recently visited the Fabrication Lab staff. Said Stephen Smeltzer, PennDesign’s
Digital Fabrications Manager, “Working on Clubber’s case was unique for us. Our work isn’t usually applied in such immediate, life-saving situations. We are proud to have played a part in giving Clubber a new lease on life.”