Zele Tilen, Matos Bostjan, Knific Jernej, Bajrović Fajko F, Prestor Borut
Faculty of Medicine, Institute of Pathophysiology, University of Ljubljana, Ljubljana, Slovenia.
Br J Neurosurg. 2010 Oct;24(5):555-60. doi: 10.3109/02688697.2010.496876.
In the present article, we assessed the role, adequacy and application accuracy of intraoperative visual guidance based on the computer 3D visualisation of preoperative medical images in the surgery of superficial brain tumours.
For 30 consecutive patients with convexity meningioma or cortical/subcortical brain tumour, we used 3D visualisation of post-contrast fast spoiled gradient recalled (FSPGR) MR images to plan optimal positions for the trepanation opening and/or corticotomy site. At the beginning of the surgery, planned positions were transferred to the scalp and the cortical surface of the patient by visually matching the 3D surfaces with the operative field. The feasibility of visual matching was assessed by counting the number of cases in which this was possible. On the exposed cortical surface, we measured the mismatch between the centre of the actual trepanation opening and the planned corticotomy site, where possible.
During computer-assisted 3D planning, the centre of the trepanation opening, initially defined on the basis of 2D diagnostic images, was redefined in all our cases by an average repositioning distance of 19.7 mm +/- 7.6 mm. During surgery, the transfer of the planned centre of the trepanation opening and the corticotomy site was possible in all (30/30) and in 70% (19/27) of the cases, respectively. Where assessable, the mismatch between the centre of the actual trepanation opening and the planned corticotomy site was less than 1 cm in 70% of cases (12/17) and more than 2 cm in 6% (1/17) of cases.
Intraoperative visual guidance based on 3D visualisation proved to be adequate and accurate for locating superficial brain tumours in cases where transfer of planned surgical targets to the surgical field was possible. Decision about its use should be based on preoperative computer-assisted 3D planning, in which the feasibility of visual matching during surgery can and must be assessed.
在本文中，我们评估了基于术前医学图像的计算机三维可视化的术中视觉引导在浅表性脑肿瘤手术中的作用、充分性和应用准确性。
对于30例连续的凸面脑膜瘤或皮质/皮质下脑肿瘤患者，我们使用增强后快速扰相梯度回波（FSPGR）磁共振图像的三维可视化来规划钻孔开口和/或皮质切开部位的最佳位置。在手术开始时，通过将三维表面与手术视野进行视觉匹配，将规划位置转移到患者的头皮和皮质表面。通过计算能够进行视觉匹配的病例数来评估视觉匹配的可行性。在暴露的皮质表面，我们尽可能测量实际钻孔开口中心与计划皮质切开部位之间的偏差。
在计算机辅助三维规划过程中，我们所有病例中最初基于二维诊断图像定义的钻孔开口中心均重新定义，平均重新定位距离为19.7毫米±7.6毫米。在手术过程中，钻孔开口计划中心和皮质切开部位的转移分别在所有病例（30/30）和70%（19/27）的病例中得以实现。在可评估的情况下，实际钻孔开口中心与计划皮质切开部位之间的偏差在70%的病例（12/17）中小于1厘米，在6%（1/17）的病例中大于2厘米。
基于三维可视化的术中视觉引导在将计划手术靶点转移到手术视野可行的情况下，被证明对于定位浅表性脑肿瘤是充分且准确的。关于其使用的决策应基于术前计算机辅助三维规划，其中手术期间视觉匹配的可行性能够且必须进行评估。
