gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Simulation of surgical approaches to brainstem tumors with 3D-fusion images

Meeting Abstract

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  • N. Saito - Department of Neurosurgery, the University of Tokyo Hospital, Tokyo, Japan
  • T. Kin - Department of Neurosurgery, the University of Tokyo Hospital, Tokyo, Japan
  • A.M. Yoshino - Department of Neurosurgery, the University of Tokyo Hospital, Tokyo, Japan

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocMI.02.01

doi: 10.3205/12dgnc003, urn:nbn:de:0183-12dgnc0033

Published: June 4, 2012

© 2012 Saito et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Owing to the development of various neuro-imaging modalities, it is now feasible to make advanced surgical strategies for difficult cases. To visualize all information in an image, we have recently developed a new method of creating a 3D-fusion image from various neuro-imaging modalities.

Methods: The fusion image was created using visualization software, AVIZOTM. Shapes of brain and cranial nerves are created from heavily T2-weighted magnetic resonance (MR) images. Arteries are from MR-angiography and/or 3D-digital subtraction angiography (DSA). Veins are taken from TRICKS (time resolved imaging of contrast kinetics) and/or 3D- DSA. Bone images from computed tomography (CT) are also fused.

Results: The fusion image enabled us to make surgical strategies more precisely. With the fusion images, it has become possible to simulate approaches to deep-seated lesions or brainstem lesions, resulting in minimizing the size of craniotomies. Identification of cranial nerves, feeders and drainers of very vascular tumors has also become much easier. We would like to emphasize that it is especially useful to simulate trajectory and entry point to the brainstem through the important structures.

Conclusions: Surgical simulation with 3D-fusion images is useful. Cases of hemangioblastomas and cavernous angiomas are presented.