gms | German Medical Science

Objective: Neurosurgical treatment decisions and strategies are more and more based on a flood tide of imaging information due to 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. There is a need to condense and compose this information to help the neurosurgeon distinguishing between what is important and what is not.

We introduce a visionary prototype of a newly developed visualization software explicitly designed for Neurosurgeons. Cutting-edge imaging modalities like probabilistic DTI (pDTI), resting-state fMRI (rsfMRI), subarachnoid cistern sequences and computational fluid dynamics (CFD) of aneurysms are visualized in 3D and virtual reality. Planning steps include skin incision, craniotomy and intraoperative patient and head clamp positioning in a realistic operative setting.

(If accepted as lecture, 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 and rsfMRI and DSA data 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 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: The use of 3D virtual reality visualization improves the surgeons understanding of anatomical and functional relations and eases neurosurgical treatment planning. 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 CFD of aneurysms was useful for surgical strategy planning and intraoperative preparation tactics due prediction of vulnerable regions.

Conclusion: Cutting-edge imaging like pDTI, rsfMRI 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.

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