Nakajima S, Atsumi H, Bhalerao A H, Jolesz F A, Kikinis R, Yoshimine T, Moriarty T M, Stieg P E
Surgical Planning Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Neurosurgery. 1997 Aug;41(2):403-9; discussion 409-10. doi: 10.1097/00006123-199708000-00013.
We used three-dimensional reconstructed magnetic resonance images for planning the operations of 16 patients with various cerebrovascular diseases. We studied the cases of these patients to determine the advantages and current limitations of our computer-assisted surgical planning system as it applies to the treatment of vascular lesions.
Magnetic resonance angiograms or thin slice gradient echo magnetic resonance images were processed for three-dimensional reconstruction. The segmentation, based on the signal intensities and voxel connectivity, separated each anatomic structure of interest, such as the brain, vessels, and skin. A three-dimensional model was then reconstructed by surface rendering. This three-dimensional model could be colored, made translucent, and interactively rotated by a mouse-controlled cursor on a workstation display. In addition, a three-dimensional blood flow analysis was performed, if necessary. The three-dimensional model was used to assist in three stages of surgical planning, as follows: 1) to choose the best method of intervention, 2) to evaluate surgical risk, 3) to select a surgical approach, and 4) to localize lesions.
The generation of three-dimensional models allows visualization of pathological anatomy and its relationship to adjacent normal structures, accurate lesion volume determination, and preoperative computer-assisted visualization of alternative surgical approaches.
Computer-assisted surgical planning is useful for patients with cerebrovascular disease at various stages of treatment. Lesion identification, therapeutic and surgical option planning, and intraoperative localization are all enhanced with these techniques.
我们使用三维重建磁共振图像为16例患有各种脑血管疾病的患者规划手术。我们研究了这些患者的病例，以确定我们的计算机辅助手术规划系统在应用于血管病变治疗时的优势和当前局限性。
对磁共振血管造影或薄层梯度回波磁共振图像进行三维重建处理。基于信号强度和体素连通性的分割将每个感兴趣的解剖结构（如脑、血管和皮肤）分开。然后通过表面渲染重建三维模型。这个三维模型可以着色、设置为半透明，并通过工作站显示器上的鼠标控制光标进行交互式旋转。此外，必要时进行三维血流分析。三维模型用于辅助手术规划的三个阶段，如下：1）选择最佳干预方法，2）评估手术风险，3）选择手术入路，4）定位病变。
三维模型的生成能够可视化病理解剖结构及其与相邻正常结构的关系，准确确定病变体积，并在术前通过计算机辅助可视化替代手术入路。
计算机辅助手术规划对处于不同治疗阶段的脑血管疾病患者有用。这些技术增强了病变识别、治疗和手术方案规划以及术中定位。
