gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

3D-MRI-based virtual endoscopy of the cerebral liquor spaces: sequence optimization and operation-planning

Meeting Abstract

  • B. Prümer - Radiologie, Clemenshospital Münster
  • S. Terwey - Neurochirurgische Klinik, Clemenshospital Münster
  • P. Bell - Radiologie, Clemenshospital Münster
  • U. Haverkamp - Radiologie, Clemenshospital Münster
  • A. Pruhs - Radiologie, Clemenshospital Münster
  • A.R. Fischedick - Radiologie, Clemenshospital Münster

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP10-01

doi: 10.3205/09dgnc353, urn:nbn:de:0183-09dgnc3539

Published: May 20, 2009

© 2009 Prümer 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: In the wake of a growing tendency towards minimally invasive therapeutic techniques endoscopic navigation and operation was introduced into neurosurgery. This study deals with the possibilities and optimization of 3D-MRI-based virtual endoscopy as a preoperative diagnostic imaging modality assisting the surgeon's navigation.

Methods: Initially, we executed a sequence-optimization for 3D-reconstructions of a hollow vessel-model with 5 sequences on a 1.0*T Magneto Expert, Siemens. Parameters read: FoV of 24cm, matrix of 256x256, and 128 partitions. An anisotropic 3D-slab of 1.2-x1.2-x1.6mm (z-axis) was calculated and post-processed on an external workstation (Vitrea, Vital Images) with an interactive, signal intensity-modulated software. The virtual endoscope assisted by the “hollow vessel“, “fly thru“, and ”cine mode“-function was used to establish standardized positions to navigate through the liquor spaces and to provide the neurosurgeon with a (sneak-)preview.

Results: In all 20 individuals 3D-MRI-based virtual endoscopy was technically feasible and images were diagnostic. The initial diagnosis relied on conventional MRI-imaging (=PD-/T2-TSE axe, STIR cur, T1-TSE axe, CE-T1-TSE axe, sag + cur). The CE-3D-T1-TSE-sequence was found to be best suited for ventricular virtual endoscopy because of its high intrinsic and CM-assisted contrast and its low vulnerability to liquor flow-induced artifacts.

In order to standardize the VE technique we suggest the use of defined starting positions for the dynamic VE (supra- and infratentorial) see Table 1 [Tab. 1].

In 5 of our 10 patients MRI diagnosed a liquor-space related pathology, which could be 3D-visualized in detail by virtual endoscopy. In the case of a medulloblastoma situated close to the pinealis VE significantly altered the neurosurgeon’s operational approach.

Conclusions: (1) MRI-based virtual endoscopy helps in diagnosing and imaging liquor space related pathologies.

(2) Because of its high intrinsic contrast and few artifacts CE-3D-T1-TSE-sequence is best suited for VE.

(3) Because VE relies on MRI (=missing radiation exposure) it is also well suited for infants and kids.

(4) In the future VE may help neurosurgeons in planning the best approach for interventional endoscopy.