Bussarsky A, Marinov M, Bussarsky V, Kalyonsky R, Tonchev Z, Wassmann H
Department of Neurosurgery, University Hospital "Alexandrovska", Medical University, Sofia, Bulgaria.
Zentralbl Neurochir. 2006 Aug;67(3):129-36. doi: 10.1055/s-2006-933535.
Virtual endoscopy (VE) is a new and promising imaging technology. Applied to neuroendoscopy it allows preoperative simulation of a procedure and evaluation of the individual intraventricular anatomy in selected cases. Along with neuronavigation and real time intraoperative imaging, VE is expected to improve the safety and efficacy of neuroendoscopic procedures.
Between April 2003 and February 2004 VE simulation was performed in 13 randomly selected patients subjected to endoscopic procedures. Pathological entities included 4 cases with aqueduct stenosis, 4 with suprasellar arachnoid cysts, 2 tumors of the posterior third ventricle, 1 colloid cyst, 1 hyperplasia of the choroid plexus and 1 case with multiloculated hydrocephalus due to intraventricular septations. In 8 patients VE was accomplished preoperatively, in another 5 it was done after the operation, using data sets from neuronavigation imaging planning in 4 patients, and in one case using postoperative imaging studies. T (1)-weighted 3D image sets were acquired on a 1.5 T GE Genesis SIGNA MR scanner and VE reconstruction was performed using the General Electric Navigator software. The VE images were compared with the real images obtained during the endoscopic procedures and evaluated for their impact on the planning of the operative approach.
VE implementation succeeded in all 13 patients. Major neuroanatomic reference structures were easily recognizable in all cases. Membranous structures such as the thinned floor of the third ventricle or cyst walls were identifiable in only 46 % of the cases. In 6 cases (46 %) VE showed anatomical variants and details relevant for the endoscopic procedure that were not identified on conventional MR images.
VE has proved to be an important adjunct to the preoperative planning of neuroendoscopic procedures and its routine application is suggested.
虚拟内镜检查（VE）是一项崭新且颇具前景的成像技术。将其应用于神经内镜检查，在特定病例中可实现术前手术模拟及对个体脑室内解剖结构的评估。与神经导航和术中实时成像技术相结合，VE有望提高神经内镜手术的安全性和有效性。
2003年4月至2004年2月期间，对13例随机选取的接受内镜手术的患者进行了VE模拟。病变类型包括4例导水管狭窄、4例鞍上蛛网膜囊肿、2例第三脑室后部肿瘤、1例胶样囊肿、1例脉络丛增生以及1例因脑室内分隔导致的多房性脑积水。8例患者在术前完成VE检查，另外5例在术后进行，其中4例使用神经导航成像规划数据集，1例使用术后成像研究数据。在1.5T的GE Genesis SIGNA MR扫描仪上获取T（1）加权三维图像集，并使用通用电气导航软件进行VE重建。将VE图像与内镜手术过程中获取的真实图像进行比较，并评估其对手术入路规划的影响。
13例患者的VE实施均获成功。所有病例中主要神经解剖参考结构均易于识别。仅46%的病例中可识别出诸如第三脑室变薄的底部或囊肿壁等膜性结构。6例（46%）VE显示出常规MR图像上未发现的与内镜手术相关的解剖变异和细节。
VE已被证明是神经内镜手术术前规划的重要辅助手段，建议常规应用。
