Low David, Lee Cheng Kiang, Dip Lee Lian Tay, Ng Wai Hoe, Ang Beng Ti, Ng Ivan
Department of Neurosurgery, National Neuroscience Institute, Singapore.
Br J Neurosurg. 2010 Feb;24(1):69-74. doi: 10.3109/02688690903506093.
To assess the utility of pre-operative 3-dimension (3D) visualisation and surgical planning with the Dextroscope in combination with the use of DEX-Ray-a novel augmented reality surgical navigation platform for resection of meningiomas in the falcine, convexity and parasagittal regions.
Magnetic resonance imaging (MRI) and magnetic resonance venogram (MRV) images of the patients were reconstructed in 3D using the Dextroscope workstation. Using a variety of available tools, we were able to view the tumour in various surgical angles and appreciate the intricate relationship of the tumour with respect to the surrounding structures and venous anatomy. Critical draining veins both superficial and deep to the tumour were well visualised. By varying the transparency of the overlying scalp and bone we were able to preoperatively determine the ideal size of our scalp flap and bone window for surgical approach. The Dextroscope enabled us to simulate surgical opening and various trajectories of approach while the DexRay virtual reality navigation system enabled the transfer of the Dextroscope 3D planning data into the operating by displaying it in real-time video-augmented mode which further enhanced the appreciation of the tumour's location in 3D space. Four patients underwent total excision of their meningioma while one patient had near total excision with a small residual remnant left behind at the medial third of the superior sagittal sinus. All 5 patients had good neurological recovery post-operatively.
The use of the Dextroscope for pre-operative surgical planning allows for appreciation of complex anatomical relationships in 3D. This appreciation is further translated for use during surgical navigation utilizing the DEX-Ray platform that provided us with the superior advantage of allowing fast and accurate surgical resection confidently.
评估使用Dextroscope进行术前三维（3D）可视化和手术规划，并结合使用DEX-Ray（一种用于切除大脑镰、凸面和矢状旁区域脑膜瘤的新型增强现实手术导航平台）的效用。
使用Dextroscope工作站对患者的磁共振成像（MRI）和磁共振静脉造影（MRV）图像进行三维重建。通过使用各种可用工具，我们能够从不同手术角度观察肿瘤，并了解肿瘤与周围结构及静脉解剖结构的复杂关系。肿瘤浅面和深面的关键引流静脉清晰可见。通过改变覆盖头皮和颅骨的透明度，我们能够在术前确定手术入路所需头皮瓣和骨窗的理想大小。Dextroscope使我们能够模拟手术开口和各种入路轨迹，而DexRay虚拟现实导航系统则通过实时视频增强模式显示Dextroscope的3D规划数据，将其传输到手术室，进一步增强了对肿瘤在三维空间中位置的认识。4例患者的脑膜瘤被完全切除，1例患者接近完全切除，在上矢状窦内侧三分之一处残留少量残余肿瘤。所有5例患者术后神经功能恢复良好。
使用Dextroscope进行术前手术规划可实现对三维复杂解剖关系的认识。这种认识在使用DEX-Ray平台进行手术导航时得到进一步应用，该平台为我们提供了快速、准确地进行手术切除的优势。
