Three-dimensional reconstruction-assisted preoperative assessment and surgical planning for pediatric tumors with complex vascular relationships: a report of two cases

BACKGROUND: Pediatric abdominal tumors with complex anatomical relationships are characterized by substantial morphological heterogeneity. Although three-dimensional reconstruction is increasingly used in surgical planning, reports that define its problem-oriented role in children with major vascular involvement remain limited. When a lesion is closely associated with major abdominal vessels, preoperative assessment should focus not only on visualization but also on resectability, preservation of critical vasculature, and perioperative risk stratification. CASE PRESENTATION: In case 1, an upper abdominal tumor was pathologically confirmed as hepatoblastoma after resection. In case 2, a retroperitoneal neurogenic tumor was pathologically diagnosed as ganglioneuroblastoma. Both children underwent preoperative three-dimensional reconstruction, which delineated the spatial relationships between the tumors, adjacent vessels, and surrounding organs, helped determine the sequence of vascular exposure, supported judgment regarding the feasibility of en bloc versus piecemeal resection, and guided dissection planning. Tumor resection was successfully completed in both patients, and short-term follow-up demonstrated favorable recovery. CONCLUSIONS: In pediatric tumors with complex relationships to major vessels, three-dimensional reconstruction enables accurate identification of high-risk anatomical features and improves preoperative risk assessment. Its principal value lies in providing actionable anatomical evidence to support complex surgical decision-making rather than merely improving anatomical visualization or replacing standard pathological diagnosis.