gms | German Medical Science

Objective: There is an accelerated progress in refinement of imaging over the last two decades. Beside new MRI sequences and functional data, other modalities like computational simulations and 3D visualization conquer our clinical routine. Clinical treatment decisions are more and more based on a flood tide of imaging information, which should be condensed and composed to support the neurosurgeon in treatment planning and during operation. We present cutting-edge imaging modalities like probabilistic DTI (pDTI), resting-state fMRI (rsfMRI), subarachnoid cistern sequences and computational fluid dynamics (CFD) of aneurysms visualized in a newly developed visualization software explicitly designed for neurosurgeons.

The authors will provide 3D-glasses during the lecture for the auditorium of the DGNC to allow the experience of virtual reality visualization.

Methods: MRI sequences for pDTI, rsfMRI and cisterns were all acquired from patients from our institution during preoperative workup. Processing of the probabilistic DTI was done with FSL (Oxford, GB), resting-state fMRI and subarachnoid cistern processing was done with an in-house developed software and CFD was done using AMIRA (FEI, France) and ANSYS (Ansys, USA). Virtual reality visualization was done with UNITY (Unity Tec., USA). Composition and visualization was performed with our newly in-house developed software, called NeuroVis.

Results: Probabilistic DTI revealed even very short and crossing fibers in the brainstem, midbrain and thalamus. Resting-state fMRI displayed brain networks of speech and higher cognitive functions. Visualization of subarachnoid cisterns and CFD of aneurysms was useful for surgical strategy planning and intraoperative preparation tactics due prediction of vulnerable regions. The use of 3D virtual reality visualization improved the surgeons understanding of anatomical and functional relations.

Conclusion: Cutting-edge imaging like pDTI, rsfMRI, subarachnoid cistern sequences and CFD of aneurysms provide precious information and can improve neurosurgical therapy in the future. Advanced visualization tools like our newly in-house developed software are indispensable to condense and compose the flood tide of anatomical and functional data in a virtual reality setting.