gms | German Medical Science

Objective: 3d processing software programs (3d PS) allow tridimensional rendering of CT/MRI images. Their widespread and costless availability made them a useful tool for preoperative planning of brain surgical procedures. 3d PS are freeware and may be easily downloaded from the web on any personal computer or laptop. Every cerebral structure (giri, sulci, vessels, etc) of the individual is displayed in order to plan the most appropriate craniotomy.

The Region and Point of interest utility (ROI and POI) allow the user to outline targeted cerebral structures and represents a further helpful feature of these programs. By this function, one can preoperatively study the anatomic relationship between eloquent cortical areas and the planned surgical field.

The observation that a POI, drawn inside the MRI of the lesion, projects on the 3d reconstructed picture orthogonally, prompted us to exploit this feature by creating a new system for the surgery of subcortical brain tumours.

Methods: This system is based upon a device that supports a catheter driver. It allows frameless procedures, both by perpendicular and oblique trajectories through a guided catheter introduced from the planned cortical entry point toward the lesion.

We describe this new system reporting two explicative cases in which perpendicular and oblique trajectories were used for the targeting and the removal of a left temporal glioblastoma and a left ventricle meningioma.

Conclusions: This 3d PS guided system proved to be a versatile, handy and costless solution for frameless surgery of deep brain masses. Furthermore, this new procedure is not biased by the brain shift occurring during surgery.