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NEWS
BOSTON CHILDREN'S HOSPITAL
30 Jul 2015

Boston Children’s Hospital physicians report the first cases of children benefiting from 3D printing of their anatomy before undergoing high-risk brain procedures. The four children had life-threatening cerebrovascular malformations (abnormalities in the brain’s blood vessels) that posed special treatment challenges. Reporting online today in the Journal of Neurosurgery: Pediatrics, the physicians describe the use of […]

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Boston Children’s Hospital physicians report the first cases of children benefiting from 3D printing of their anatomy before undergoing high-risk brain procedures. The four children had life-threatening cerebrovascular malformations (abnormalities in the brain’s blood vessels) that posed special treatment challenges.

Reporting online today in the Journal of Neurosurgery: Pediatrics, the physicians describe the use of 3D printing and synthetic resins to create custom, high-fidelity models of the children’s vessel malformations along with nearby normal blood vessels. In some cases, the surrounding brain anatomy was also printed.

“These children had unique anatomy with deep vessels that were very tricky to operate on,” says Boston Children’s neurosurgeon Edward Smith, MD, senior author of the paper and co-director of the hospital’s Cerebrovascular Surgery and Interventions Center. “The 3D-printed models allowed us to rehearse the cases beforehand and reduce operative risk as much as we could.”

The children ranged in age from 2 months to 16 years old. Three of the four children had arteriovenous malformations (AVMs), in which tangles of arteries and veins connect abnormally, and were treated surgically.

“AVMs are high-risk cases and it’s helpful to know the anatomy so we can cut the vessels in the right sequence, as quickly and efficiently as possible,” says Smith. “You can physically hold the 3D models, view them from different angles, practice the operation with real instruments and get tactile feedback.”

The 2-month-old infant had a rare vein of Galen malformation in which arteries connect directly with veins—bypassing the capillaries—and was treated with an interventional radiology technique to seal off the malformed blood vessels from the inside.

“Even for a radiologist who is comfortable working with and extrapolating from images on the computer to the patient, turning over a 3D model in your hand is transformative,” says Darren Orbach, MD, PhD, chief of Interventional and Neurointerventional Radiology at Boston Children’s and co-director of the Cerebrovascular Surgery and Interventions Center. “Our brains work in three dimensions, and treatment planning with a printed model takes on an intuitive feel that it cannot otherwise have.”

The life-sized and enlarged 3D models were created in collaboration with the Boston Children’s Hospital Simulator Program (SIMPeds) using brain magnetic resonance (MR) and MR arteriography data from each child. Measurements of the models showed 98 percent agreement with the children’s actual anatomy.

All four children’s malformations were successfully removed or eliminated with no complications. When two of the AVM patients were compared with controls who did not have 3D-printed models—matched for age, size and type of AVM, surgeon and operating room—those with 3D models had their surgical time reduced by 12 percent (30 minutes). (Actual surgical time was 254 and 257 minutes for the cases with 3D models and 285 and 288 minutes for the controls.) Even a 30-minute reduction is significant for children who are especially sensitive to anesthesia.

Smith and Orbach are continuing to use 3D models for their trickier cases. “3D printing has become a regular part of our process,” says Smith. “It’s also a tool that allows us to educate our junior colleagues and trainees in a way that’s safe, without putting a child at risk.”

SIMPeds director Peter Weinstock, MD, PhD, was first author on the paper; co-authors were Orbach, Sanjay Prabhu, MBBS, FRCR, and Katie Flynn, BS, ME, all of Boston Children’s Hospital. The study was supported by the Lucas Warner AVM Research Fund and The Kids At Heart Neurosurgery Research Fund.

 

NEWS
NEW YORK TIMES
18 Feb 2015

New York Times The Metropolitan Opera said on Wednesday that it would redouble its efforts to attract new audiences to the opera next season with six new productions, a star-filled roster and new initiatives, including one that will offer half-priced tickets to children during the holidays and another to court young professionals with later curtain […]

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New York Times

The Metropolitan Opera said on Wednesday that it would redouble its efforts to attract new audiences to the opera next season with six new productions, a star-filled roster and new initiatives, including one that will offer half-priced tickets to children during the holidays and another to court young professionals with later curtain times, discounts and social events.

“The future of opera relies upon bringing new audiences in, as we all know,” Peter Gelb, the Met’s general manager, said in an interview. “Ultimately, no matter what the economics are, how daunting they are, or how successful we are in fund-raising, at the end of the day it’s all about having an audience.”

While the initiatives are aimed at newcomers, the season should offer plenty to interest regular operagoers. Nina Stemme, the acclaimed Swedish dramatic soprano whose New York appearances have been few and far between, will return to the Met next season to sing the title roles in a new production of Strauss’s “Elektra” and a revival of Puccini’s “Turandot.”

The star tenor Jonas Kaufmann and the soprano Kristine Opolais will perform in a new production of Puccini’s “Manon Lescaut” directed by Richard Eyre. James Levine, the Met’s music director, will conduct a new production of Berg’s “Lulu,” which he described in an interview as “an inspired work, from beginning to end.” The production will be staged by the South African artist William Kentridge, who did the Met’s innovative production of “The Nose.”

And, reprising a feat that Beverly Sills was famous for, Sondra Radvanovsky will sing all three queens in Donizetti’s so-called Tudor trilogy next season. She will sing the title roles in revivals of “Anna Bolena” and “Maria Stuarda” and then, when the Met brings “Roberto Devereux” to its stage for the first time in a new David McVicar production, she will perform the role of Elizabeth I, who, unlike the other two queens, manages to keep her head.

Two more new productions will round out the season: The Met will stage its first production of Bizet’s “Les Pêcheurs de Perles” (The Pearl Fishers) since 1916. It will be directed by Penny Woolcock; conducted by Gianandrea Noseda; and star Diana Damrau, Matthew Polenzani and Mariusz Kwiecien. (Mr. Gelb noted that the last tenor to sing the role Mr. Polenzani is singing was Enrico Caruso. “Hopefully there’s been enough time in between,” he said.)

And the Met will open its season with a new production of Verdi’s “Otello” directed by Bartlett Sher; conducted by Yannick Nézet-Séguin; and starring Sonya Yoncheva, who had several star-making turns this season, as Desdemona, and Aleksandrs Antonenko in the title role.

Some of the big moments of the season will be in revivals: Anna Netrebko, who made a splash this year in Verdi’s “Macbeth,” will sing Leonora in Verdi’s “Il Trovatore” for the first time at the Met. She will make her New York recital debut with a solo concert on Feb. 28, 2016.

 

The Met, which has been struggling financially and at the box office in recent seasons — it ran a $22 million deficit last year — announced a series of steps to court new audiences.

Children under 18 will be able to receive half-price tickets in any section of the house between Thanksgiving and New Year’s Eve, when purchased with a full-priced ticket.

A new program called “Fridays Under Forty” will offer tickets on selected Friday nights to people under 40 for $60 and $100 and move the curtain time back to 8 p.m., from its usual 7:30 p.m., to accommodate young professionals who work long hours.

And the Met plans to build on its popular holiday presentations aimed at families by adding one for grown-ups. So in addition to reviving an abridged, English-language revival of Rossini’s “The Barber of Seville” aimed at children, starring Isabel Leonard as Rosina, the Met will add one for adults: a streamlined revival of Johann Strauss’s “Die Fledermaus,” conducted, for his first time, by Mr. Levine.

The average ticket price will increase by 1 percent to $160, the Met said. Tickets will range in price from $25 to $480, with 36 percent of the roughly 900,000 tickets available next season for under $100, and more than half available for under $150.

Mr. Levine is to conduct five operas next season. In addition to “Lulu” and “Die Fledermaus,” he will conduct Verdi’s “Simon Boccanegra” with Plácido Domingo in the title role; Mozart’s “Die Entführung aus dem Serail”; and Wagner’s “Tannhäuser” starring Johan Botha, Peter Mattei, Eva-Maria Westbroek and Michelle DeYoung.

There are no contemporary works next season, but the Met, which has made a greater priority of new works in recent years, announced that it had commissioned a new opera by Nico Muhly, the composer of “Two Boys.” Mr. Muhly will write “Marnie,” based on the 1961 Winston Graham novel that was adapted for the screen by Alfred Hitchcock, and which is scheduled to come to the Met’s stage, in a production directed by Michael Mayer, in the 2019-20 season.

“It does everything that you want an opera to do, really,” Mr. Muhly said of the book. “It’s really, really dark.”