gms | German Medical Science

Objective: Planning is a crucial factor for successful treatment in neurosurgery. 3D visualization (3D) and virtual reality (VR) allows for superior image data presentation, condenses image information and accommodates our stereopsis habits. We developed a neurosurgical planning tool which allows 3D and VR of individual brain anatomy and simulates an entire operation room (VR-OR). In this study, the potential advantages of 3D and VR for surgical planning are explained on the bases of representative cases from daily practice. (If accepted as lecture, the authors could provide 3D-glasses during the lecture for the auditorium of the DGNC to allow the experience of virtual reality visualization.)

Methods: MRI sequences were acquired from patients from our institution during preoperative workup. Segmentations of brain tissues and skull were done with FAST (FMRIB's Automated Segmentation Tool, Analyses Group, Oxford, UK) and Amira (Thermo Fisher Scientific, Massachusetts, US). Composition and 3D visualization was performed with our newly in-house developed software, called NeuroVis. A cross platform game engine (Unity Technologies, San Francisco, US) was used to create 3D environment for VR.

Results: We developed a robust and fast semi-automated workflow to implement individual segmented brains into a 3D viewer and VR-OR setting including an OR table and a fully adjustable Mayfield head clamp. By the means of concrete case-studies (tumors in eloquent areas, of the pinealis region, skull base tumors, aneurysms and AVMs) we illustrate the advantages of 3D and VR: intuitive and fast understanding of complex anatomical and functional relations, the ease of recognizing and engraving the location of risk structures and the possibility to simulate instantly different approaches and dissection strategies.

Conclusion: Due to the outstanding tangible and impressive presentation of complex image data, 3D and VR is particularly suitable for individual surgical planning in neurosurgery. It can improve the understanding of complex anatomy and helps the neurosurgeon to make an indication, to select the right approach and dissection strategy and to avoid pitfalls. It can reduce the learning curve for young neurosurgeons. Because of its superiority to present complex image information and its ability to simulate approaches it will become indispensable for teaching, training, planning and the surgery itself.

Figure 1 [Fig. 1], Figure 2 [Fig. 2]