3-year-old whose head was four times normal size receives 3D printed skull and brain shrinkage surgery
What’s more, the condition was steadily worsening. The girl had been bedridden since September 2014, while the pressure was causing severe infections and was squeezing the optic nerve to blind her. According to hospital experts, Han Han’s life was in grave danger. After repeated discussions and meeting with the family, the team of neurosurgeons decided on a ground breaking surgery called ‘whole brain shrinking’ surgery, that include the drainage of all fluid, the repair of the various scalp defects it had caused and the insertion of a 3D printed titanium skull to replace the very brittle one she had.
Before surgery could begin, however, Han Han underwent nearly two months of careful treatment to optimize her condition and increase her chances of survival. Gaining about 4 kgs, her skull also shrank 4 centimeters while the ulcerations were treated. However, surgery remained very risky but unavoidable. Beginning in the early hours of 14 July, the team of neurosurgeons set out for the complicated task. The first step was to strip off the periosteum and to wrap a saline pad around her head for protection. Afterwards, the entire skull was carefully peeled off – something reporters compared to peeling off an onion skull. A ventricular drainage tube was inserted to slowly start draining the excess fluid, enabling the brain tissue to respond to the decreased pressure. The young girl’s brain slowly reached a normal size, after which a 3D printed titanium mesh (based on CT scans and 3D printed beforehand) was placed over her brain, followed by a 3D printed skull. Finally, the scalp was placed back over the 3D printed skull, and the whole area was repaired and cleaned.
It was, in short, a long and arduous surgery, filled with potential pitfalls. In total, surgeons were busy for 17 hours. ‘It was a considerably difficult surgery, particularly because of Han Han’s young age, which greatly limits her ability to tolerate surgery for longer periods of time. Physical signs of change could occur at any time. But as this is the world’s first surgery of its kind, we had no clinical experience and needed to be one hundred percent accurate,’ the chief surgeon told reporters. During preparation, the doctors reportedly took a lot of cues from a successful brain cancer surgery that took place in April 2013, as it also required a 3D printed titanium skull implant.
The young girl was taken to the intensive care unit at 2:30 in the morning for postoperative recovery. However, according all reports, the surgery was smooth and stable, despite the risks involved. Her father already saw some improvement in her health, as Han Han was able to wink to her father already while her hand movement was exactly as it should be. It still, however, remains to be seen how her sight is affected by the removal of pressure, or if any brain damage was caused during the surgery. Spontaneous bleeding and postoperative infections are also still real possibilities. While it will thus be a long time before Han Han gets to live a normal life, she’s on the road to recovery.
But that wasn’t the only good news. While the family had initially gathered funds to pay for the surgery through an online crowdfunding campaign, the hospital’s dean Tan Li revealed to reporters that the hospital had decided not to charge the family for Han Han’s surgery or subsequent treatments, as they want to make every effort they can to help Han Han have a healthy future. Let’s hope they succeed.
Chinese academic hospitals are slowly building up a reputation for being innovative adopters of 3D medical printing. After all, we hear about new and exciting medical applications of 3D printing technology in China on an almost daily basis; just yesterday, we learned that a Chinese bone 3D printing project will be entering its animal testing phase. However, another recent report from Zhuzhou really takes things to a completely different level in terms of innovation. There, the three year old Han Han successfully underwent a brain shrinkage surgery while receiving a 3D printed titanium skull implant that accurately fits the new brain.
This remarkable operation the Second People’s Hospital of Hunan Province followed a remarkable condition, because Han Han had been suffering from a very rare condition. As the hospital’s chief neurosurgeon professor Kuang Weiping explained, the three year old girl suffered from severe congenital hydrocephalus – a condition where the head swells up enormously, up to four times a normal volume.
And this is clearly visible in the young girl; whereas an ordinary human head is about 45-47 cm in circumference, the young girl’s head was approximately twice as large, 85% of which consisted of intracranial water. Now water reaches all of our brains, but is usually absorbed at a steady pace. Not only did the young girl have a remarkably thin and brittle skull, the 20 kg body was unable to prop up all that weight herself. The girl was called ‘Big Head’ by her family.
The young girl was born in a town near Zhuzhou City, and was her family noticed the growth of her head when she was just four months old. At six months, she was diagnosed with the condition, which caused great distress in her home. Her mother left the family, and her laborer father was always working, leaving the girl in the care of her grandparents. As the grandmother said, they only had access to an acupuncture treatment from a village doctor, while regularly washing the pillow and head – a horrible situation.