Auer L M, Auer D P
Department of Neurosurgery, Saarland University, Medical School, Homburg, Germany.
Neurosurgery. 1998 Sep;43(3):529-37; discussion 537-48. doi: 10.1097/00006123-199809000-00072.
This article demonstrates the usefulness and the problems of present-state software for virtual endoscopy as a tool for the planning and simulation of minimally invasive neurosurgical procedures.
The software Navigator (General Electric Medical Systems, Buc, France) was applied for virtual endoscopic visualization of three-dimensional magnetic resonance data sets of healthy volunteers and neurosurgical patients, using a clinical magnetic resonance scanner (1.5-T Signa Hispeed; General Electric Medical Systems). Classical approaches for minimally invasive procedures were simulated.
Virtual endoscopy provided impressive three-dimensional views of intracranial and intracerebral cavities, with visualization of many anatomic details of the brain's inner and outer surfaces. The method proved to be especially suited for the simulation and planning of operations of intraventricular lesions, for which the technical limitations of the present state of development of this method have fewer implications. However, the present state of technology, as described in this article, has two major shortcomings: 1) the blood vessels cannot be visualized together with the brain tissue and cranial nerves; and 2) different tissue compartments cannot be stained in their original coloring, which would facilitate their recognition and thus orientation in space by anatomic landmarks. Another important disadvantage at this stage is time consumption for many single working steps.
Virtual endoscopy is a promising tool for teaching and training in intracranial neuroanatomy as well as for planning and simulation of minimally invasive (e.g., endoscopic), mainly intraventricular, operations. Direct clinical application is, at this stage of development, limited by several technical shortcomings of visualization and quantification of distances and modeling of surfaces.
本文展示了当前虚拟内窥镜软件作为微创神经外科手术规划和模拟工具的实用性及存在的问题。
使用临床磁共振扫描仪（1.5-T Signa Hispeed；通用电气医疗系统公司），应用Navigator软件（通用电气医疗系统公司，法国布克）对健康志愿者和神经外科患者的三维磁共振数据集进行虚拟内窥镜可视化，并模拟了微创外科手术的经典方法。
虚拟内窥镜提供了令人印象深刻的颅内和脑内腔三维视图，可视化了脑内外表面的许多解剖细节。该方法被证明特别适用于脑室内病变手术的模拟和规划，在该方法当前的发展状态下，其技术局限性对此类手术的影响较小。然而，如本文所述，目前的技术水平存在两个主要缺点：1）血管无法与脑组织和颅神经一起可视化；2）不同的组织腔室无法按其原始颜色染色，而这将有助于通过解剖标志对其进行识别并在空间中定位。现阶段另一个重要缺点是许多单个工作步骤耗时较长。
虚拟内窥镜是颅内神经解剖教学和培训以及微创（如内窥镜）手术（主要是脑室内手术）规划和模拟的一种有前景的工具。在现阶段的发展中，其直接临床应用受到可视化、距离量化和表面建模等多项技术缺点的限制。
