gms | German Medical Science

Objective: Increasingly augmented reality and 3D applications are making their way into the operating theatre. We evaluated the advantages of using a three-dimensional reconstruction of the individual anatomy using the superficial cerebral veins for surgical planning and intraoperative guidance in brain tumor surgery.

Method: In 10 eligible patients 3D brain surface visualization was performed and tested intraoperatively with different lesions. All underwent preoperative brain MR imaging. AMIRA^® (Visualization Sciences Group, USA) software package v. 5.4. was used on standard PCs. External software package FSL (University of Oxford, UK) was implemented and batch script files for complete automation of image preprocessing were created. Fast image preprocessing on GPU was established and 3D-visualization with shutter-glasses was installed. Detectability of superficial cortical vessels was measured and compared. The usefulness was evaluated by comparing the simulation images with intraoperative photographs and each surgeon provided feedback concerning the efficacy.

Results: For the presurgical planning an automated and fast workflow of image preprocessing could be established. This included image co-registration, skull stripping, segmentation and visualization of available MR image modalities. 3D visualization was performed by direct volume rendering. Different MRI sequences were screened for their spatial resolution and detectability of cortical vessels when compared to intraoperative findings. Visual information could substantially be enhanced by 3D-visualization and well-prepared segmentation with a building block concept.

Conclusions: Superficial cerebral veins can be an important landmark in neurosurgery and their preoperative 2D and 3D visualization with implementation into surgical planning software can adjust for brainshift and be helpful for realizing the planned approach with more accuracy. The algorithm and tools that were used for preparation proved safe and reliable and allowed time to focus on visualization and approach-planning. This method could also be useful for the treatment of other neurosurgical entities.