Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
J Neurosurg. 2012 Sep;117(3):555-65. doi: 10.3171/2012.5.JNS112334. Epub 2012 Jun 29.
The purpose of this paper is to report on the authors' advanced presurgical interactive virtual simulation technique using a 3D computer graphics model for microvascular decompression (MVD) surgery.
The authors performed interactive virtual simulation prior to surgery in 26 patients with trigeminal neuralgia or hemifacial spasm. The 3D computer graphics models for interactive virtual simulation were composed of the brainstem, cerebellum, cranial nerves, vessels, and skull individually created by the image analysis, including segmentation, surface rendering, and data fusion for data collected by 3-T MRI and 64-row multidetector CT systems. Interactive virtual simulation was performed by employing novel computer-aided design software with manipulation of a haptic device to imitate the surgical procedures of bone drilling and retraction of the cerebellum. The findings were compared with intraoperative findings.
In all patients, interactive virtual simulation provided detailed and realistic surgical perspectives, of sufficient quality, representing the lateral suboccipital route. The causes of trigeminal neuralgia or hemifacial spasm determined by observing 3D computer graphics models were concordant with those identified intraoperatively in 25 (96%) of 26 patients, which was a significantly higher rate than the 73% concordance rate (concordance in 19 of 26 patients) obtained by review of 2D images only (p < 0.05). Surgeons evaluated interactive virtual simulation as having "prominent" utility for carrying out the entire surgical procedure in 50% of cases. It was evaluated as moderately useful or "supportive" in the other 50% of cases. There were no cases in which it was evaluated as having no utility. The utilities of interactive virtual simulation were associated with atypical or complex forms of neurovascular compression and structural restrictions in the surgical window. Finally, MVD procedures were performed as simulated in 23 (88%) of the 26 patients .
Our interactive virtual simulation using a 3D computer graphics model provided a realistic environment for performing virtual simulations prior to MVD surgery and enabled us to ascertain complex microsurgical anatomy.
本文旨在介绍作者使用三维计算机图形模型进行微血管减压（MVD）手术的术前交互式虚拟模拟技术。
作者对 26 例三叉神经痛或面肌痉挛患者进行了术前交互式虚拟模拟。交互式虚拟模拟的三维计算机图形模型由脑干、小脑、颅神经、血管和颅骨单独组成，通过对 3-T MRI 和 64 排多层 CT 系统采集的数据进行图像分析，包括分割、表面渲染和数据融合来创建。交互式虚拟模拟是通过使用新型计算机辅助设计软件并操纵触觉设备来模拟骨钻和小脑牵拉等手术步骤来完成的。将模拟结果与术中发现进行比较。
在所有患者中，交互式虚拟模拟均提供了详细逼真的手术视角，质量足够高，代表了侧枕下入路。通过观察三维计算机图形模型确定三叉神经痛或面肌痉挛的病因，与 26 例患者中 25 例（96%）的术中发现一致，明显高于仅通过二维图像评估时 73%的一致性率（26 例患者中 19 例一致）（p < 0.05）。有 50%的患者认为交互式虚拟模拟在执行整个手术过程中具有“显著”的实用性，50%的患者认为它具有中等实用性或“辅助性”。没有患者认为它没有用处。交互式虚拟模拟的实用性与神经血管压迫的非典型或复杂形式以及手术窗中的结构限制有关。最后，26 例患者中的 23 例（88%）按照模拟进行了 MVD 手术。
我们使用三维计算机图形模型进行的交互式虚拟模拟为 MVD 手术前的虚拟模拟提供了真实的环境，并使我们能够确定复杂的显微解剖结构。
