Kakizawa Yukinari, Hongo Kazuhiro, Takasawa Hisayoshi, Miyairi Yosuke, Sato Atsushi, Tanaka Yuichiro, Kobayashi Shigeaki
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
J Neurosurg. 2003 Mar;98(3):625-30. doi: 10.3171/jns.2003.98.3.0625.
Three-dimensional (3D) neuroimages are generally considered useful for neurosurgical practice. Nevertheless, neuroimaging modalities such as 3D digital subtraction angiography and 3D computerized tomography angiography are still insufficient because the resulting images fail to delineate neural structures. Complex neurosurgical procedures are mostly performed in the cerebrospinal fluid (CSF) space of the basal cistern, where vessels and neural structures are present along with the lesion. The magnetic resonance (MR) imaging-derived 3D constructive interference in steady-state (CISS) imaging displays the margin between the CSF and neural structures, vessels, and dura mater in detail, in a two-dimensional fashion. The authors know that volume-rendered 3D CISS images would be more useful for surgery than conventional ones. Although the usefulness of "virtual MR image endoscopy" was reported previously, the endoscopic view is different from the operative field because of the perspective being emphasized. Therefore, to simulate surgical views, the authors made 3D neuroimages from a 3D CISS MR sequence by using an advanced computer workstation. After generating volume images, a cutting method was used in the desired plane to visualize the lesion with reference to a multiplanar reformatted image. The authors call these "real" 3D CISS images, and they are more comparable to the operative field. This newly developed method of producing a real 3D CISS image was used in 30 cases and contributed to the understanding of the relationship between a lesion and surrounding structures before attempting neurosurgical procedures, with minimal invasiveness to the patient.
三维（3D）神经影像通常被认为对神经外科手术实践有用。然而，诸如3D数字减影血管造影和3D计算机断层血管造影等神经成像方式仍然存在不足，因为所得图像无法清晰描绘神经结构。复杂的神经外科手术大多在脑基底池的脑脊液（CSF）空间中进行，此处血管、神经结构与病变同时存在。磁共振（MR）成像衍生的稳态三维建设性干扰（CISS）成像以二维方式详细显示了脑脊液与神经结构、血管和硬脑膜之间的边界。作者知道，容积再现的3D CISS图像在手术中比传统图像更有用。尽管此前已有关于“虚拟MR图像内镜检查”有用性的报道，但由于强调视角的原因，内镜视图与手术视野不同。因此，为了模拟手术视野，作者使用先进的计算机工作站从3D CISS MR序列生成3D神经影像。生成容积图像后，在所需平面上使用切割方法，参照多平面重组图像来可视化病变。作者将这些称为“真实”的3D CISS图像，它们与手术视野更具可比性。这种新开发的生成真实3D CISS图像的方法应用于30例病例，有助于在尝试进行神经外科手术前了解病变与周围结构的关系，同时对患者的侵袭性最小。
