Departments of1Neurosurgery and.
2Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India.
Neurosurg Focus. 2021 Aug;51(2):E23. doi: 10.3171/2021.5.FOCUS21236.
OBJECTIVE: Different techniques of performing image-guided neurosurgery exist, namely, neuronavigation systems, intraoperative ultrasound, and intraoperative MRI, each with its limitations. Except for ultrasound, other methods are expensive. Three-dimensional virtual reconstruction and surgical simulation using 3D volume rendering (VR) is an economical and excellent technique for preoperative surgical planning and image-guided neurosurgery. In this article, the authors discuss several nuances of the 3D VR technique that have not yet been described. METHODS: The authors included 6 patients with supratentorial gliomas who underwent surgery between January 2019 and March 2021. Preoperative clinical data, including patient demographics, preoperative planning details (done using the VR technique), and intraoperative details, including relevant photos and videos, were collected. RadiAnt software was used for generating virtual 3D images using the VR technique on a computer running Microsoft Windows. RESULTS: The 3D VR technique assists in glioma surgery with a preoperative simulation of the skin incision and craniotomy, virtual cortical surface marking and navigation for deep-seated gliomas, preoperative visualization of morbid cortical surface and venous anatomy in surfacing gliomas, identifying the intervenous surgical corridor in both surfacing and deep-seated gliomas, and pre- and postoperative virtual 3D images highlighting the exact spatial geometric residual tumor location and extent of resection for low-grade gliomas (LGGs). CONCLUSIONS: Image-guided neurosurgery with the 3D VR technique using RadiAnt software is an economical, easy-to-learn, and user-friendly method of simulating glioma surgery, especially in resource-constrained countries where expensive neuronavigation systems are not readily available. Apart from cortical sulci/gyri anatomy, FLAIR sequences are ideal for the 3D visualization of nonenhancing diffuse LGGs using the VR technique. In addition to cortical vessels (especially veins), contrast MRI sequences are perfect for the 3D visualization of contrast-enhancing high-grade gliomas.
目的:现有的影像引导神经外科技术包括神经导航系统、术中超声和术中磁共振成像,每种技术都有其局限性。除了超声之外,其他方法都很昂贵。使用三维容积再现(VR)进行三维虚拟重建和手术模拟是一种经济且优秀的术前手术计划和影像引导神经外科技术。本文作者讨论了一些尚未描述的 3D VR 技术细节。
方法:作者纳入了 2019 年 1 月至 2021 年 3 月期间接受手术治疗的 6 例幕上胶质瘤患者。收集了包括患者人口统计学数据、术前规划细节(使用 VR 技术完成)以及术中细节,包括相关照片和视频等临床资料。使用 RadiAnt 软件在运行 Microsoft Windows 的计算机上使用 VR 技术生成虚拟三维图像。
结果:3D VR 技术可辅助胶质瘤手术,包括术前模拟皮肤切口和开颅术、深部胶质瘤的虚拟皮质表面标记和导航、表面胶质瘤病损皮质表面和静脉解剖结构的术前可视化、识别表面和深部胶质瘤的静脉间手术通道,以及术前和术后虚拟三维图像突出显示低级别胶质瘤(LGGs)的肿瘤确切空间几何残留位置和切除范围。
结论:使用 RadiAnt 软件的 3D VR 技术进行影像引导神经外科手术是一种经济、易于学习和用户友好的模拟胶质瘤手术的方法,尤其适用于昂贵的神经导航系统不易获得的资源有限的国家。除了皮质沟回解剖结构之外,FLAIR 序列也是使用 VR 技术对无强化弥漫性 LGG 进行三维可视化的理想选择。除了皮质血管(特别是静脉)之外,对比增强 MRI 序列也是增强型高级别胶质瘤的三维可视化的理想选择。
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