Computer assisted pre-operative interactive 3-d planning of surgical procedures in neurosurgery
Abstract
Background: Present paper describes our experiences with the use of three-dimensional (3D) reconstruction of medical images for pre-operative planning and intra-operative navigation in neurosurgery of cortical and sub-cortical tumors.
Methods: In 10 patients with cortical and sub-cortical tumors, before surgery 3D models of tumor, normal nearby brain tissue and cortical veins were reconstructed from magnetic resonance images and in selected cases functional magnetic resonance images using the computer program »3D Slicer«. Based on these models, the skin incision, trepanation opening and trans-cortical approach to the tumor were planned in virtual 3D computer space. Collected positional data were transferred from the 3D computer space to the operation field using distances from the artificial and typical anatomical landmarks on skin and cortical surface.
Results: Computer assisted 3D reconstruction provided a surgeon with more accurate localization of tumor than conventional mental reconstruction of the 2D medical images. In all cases the position, size and shape of skin incision, trepanation opening, cortical veins, sulci and gyri visualized on computer screen before surgery matched the actual anatomy observed during surgical procedure. In all patients the lesion was precisely found and macroscopically totally resected with minimal injury to the adjacent normal structures.
Conclusions: Pre-operative computer assisted 3D reconstruction provides important additional information about spatial localization of cortical and sub-cortical tumors in comparison to mental reconstruction of 2D medical images. Therefore, it improves the accuracy of planning the surgical procedure and makes it less invasive and less risky.
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References
Peters TM. Image-guided surgery: from X-rays to virtual reality. Comput Methods Biomech Biomed Engin 2000; 4: 27–57.
Nabavi A, Kacher DF, Gering DT, Pergolizzi RS, Wells WM III, Wong TZ, et al. Neurosurgical procedures in a 0.5 tesla, openconfiguration intraoperative MRI: planning, visualization, and navigation. Automedica 2001; 00: 1–35. Dosegljivo na: splweb.bwh.harvard.edu:8000/pages/papers/arya/automedica 2001/automedica2001.pdf
Jacobs AH, Kracht LW, Gossmann A, Ruger MA, Thomas AV, Thiel A, Herholz K. Imaging in neurooncology. NeuroRx 2005; 2: 333–47.
American society of neuroimaging. History of neuroimaging. Dosegljivo na: snap.asnweb.org/index.php?src = gendocs&link = NeuroImagingHistory&category = History
Kikinis R, Gleason PL, Moriarty TM, Moore MR, Alexander E 3rd, Stieg PE, et al. Computer-assisted interactive three-dimensional planning for neurosurgical procedures. Neurosurgery 1996; 38: 640–9.
Gering DT, Nabavi A, Kikinis R, Hata N, O’Donnell LJ, Grimson WE, et al. An integrated visualization system for surgical planning and guidance using image fusion and an open MR. J Magn Reson Imaging 2001; 13: 967–75.
ANALYZE Program. Dosegljivo na: www.mayo.edu/bir/Software/Analyze/Analyze.html
MEDx Software. Dosegljivo na: www.medicalnumerics.com
MNI Software. Dosegljivo na: www.bic.mni.mcgill.ca/software/
BrainLAB. Dosegljivo na: www.brainlab.com
Colchester AC, Zhao J, Holton-Tainter KS, Henri CJ, Maitland N, Roberts PT, et al. Development and preliminary evaluation of VISLAN, a surgical planning and guidance system using intraoperative video imaging. Med Image Anal 1996; 1: 73–90.
Jannin P, Fleig OJ, Seigneuret E, Grova C, Morandi X, Scarabin JM. A data fusion environment for multimodal and multi-informational neuronavigation. Comput Aided Surg 2000; 5: 1–10.
Zamorano L, Jiang Z, Kadi AM. Computer-assisted neurosurgery system: Wayne State University hardware and software configuration. Comput Med Imaging Graph 1994; 18: 257–71.
D Slicer. Dosegljivo na: www.slicer.org
Chabrerie A, Nabavi A, Ozlen F, Leventon ME, Chatsidakis E, Nakajima S, et al. Three-dimensional reconstruction for cortical surgery: The Brigham and Women’s hospital experience. Techniques in Neurosurgery 2001; 7: 61–9.
Nakajima S, Atsumi H, Kikinis R, Moriarty TM, Metcalf DC, Jolesz FA, Black PM. Use of cortical surface vessel registration for image-guided Neurosurgery. Neurosurgery 1997; 40: 1201–8.
Ganslandt O, Behari S, Gralla J, Fahlbusch R, Nimsky C. Neuronavigation: concept, techniques and applications. Neurol India 2002; 50: 244–55.
Ravnik J, Lipovšek M, Milojković V, Strojnik T, Šeruga T, Vinter M, Bunc G. Uporaba nevronavigacijskega sistema na Oddelku za nevrokirurgijo Splošne bolnišnice Maribor. Zdrav Vestn 2004; 73: 657–62.
Keles GE. Intracranial neuronavigation with intraoperative magnetic resonance imaging. Curr Opin Neurol 2004;17: 497–500.
Albayrak B, Samdani AF, Black PM. Intra-operative magnetic resonance imaging in neurosurgery. Acta Neurochir (Wien) 2004; 146: 543–56.
Unsgaard G, Rygh OM, Selbekk T, Muller TB, Kolstad F, Lindseth F, Hernes TA. Intra-operative 3D ultrasound in neurosurgery. Acta Neurochir (Wien) 2006; 148: 235–53.
Gasser T, Ganslandt O, Sandalcioglu E, Stolke D, Fahlbusch R, Nimsky C. Intraoperative functional MRI: implementation and preliminary experience. Neuroimage 2005; 26: 685–93.
Ecker RD, Goerss SJ, Meyer FB, Cohen-Gadol AA, Britton JW, Levine JA. Vision of the future: initial experience with intraoperative real-time high-resolution dynamic infrared imaging. Technical note. J Neurosurg 2002; 97: 1460–71.
Black P, Jaaskelainen J, Chabrerie A, Golby A, Gugino L. Minimalist approach: functional mapping. Clin Neurosurg 2002; 49: 90– 102.
Yetkin FZ, Mueller WM, Morris GL, McAuliffe TL, Ulmer JL, Cox RW, et al. Functional MR activation correlated with intraoperative cortical mapping. AJNR Am J Neuroradiol 1997; 18: 1311–5.
Lee CC, Ward HA, Sharbrough FW, Meyer FB, Marsh WR, Raffel C, et al. Assessment of functional MR imaging in neurosurgical planning. AJNR Am J Neuroradiol 1999; 20: 1511–9.
Benveniste RJ, Germano IM. Correlation of factors predicting intraoperative brain shift with successful resection of malignant brain tumors using image-guided techniques. Surg Neurol 2005; 63: 542–8.
Nabavi A, Gering DT, Kacher DF, Talos IF, Wells WM, Kikinis R, et al. Surgical navigation in the open MRI. Acta Neurochir Suppl 2003; 85: 121–5.
Seifert V. Intraoperative MRI in neurosurgery: technical overkill or the future of brain surgery? Neurol India 2003; 51: 329–32.
Warfield SK, Haker SJ, Talos IF, Kemper CA, Weisenfeld N, Mewes AU, et al. Capturing intraoperative deformations: research experience at Brigham and Women’s Hospital. Med Image Anal 2005; 9: 145–62.
Carter TJ, Sermesant M, Cash DM, Barratt DC, Tanner C, Hawkes DJ. Application of soft tissue modelling to image-guided surgery. Med Eng Phys 2005; 27: 893–909.
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