A New Method of Directing Endoscope Pathway in Single-Nostril Transpheoidal Approach for Safety by Using Volume Rendering With Thin-Section Computed Tomographic Image

Three-Dimensional Volume Rendering: An Underutilized Tool in Neurosurgery

OBJECTIVE

Two-dimensional radiologic images of computed tomography (CT) and magnetic resonance imaging (MRI) examinations are insufficient to provide three-dimensional conception of intracranial or spinal lesions, especially for an inexperienced neurosurgeon. We share our experience of applications of volume rendering (VR) images of CT and MRI studies of brain and spine for the purpose of training and surgical planning in neurosurgery.

METHODS

Digital Imaging and Communications in Medicine viewer software was used on a personal computer/laptop to view CT and MRI examinations of various lesions of brain, spine, and spinal cord. Various user-friendly applications of the software enable users to edit the images acquired.

RESULTS

Imaging technique (CT and MRI) incorporating continuous or overlapping slice with slice thickness of 1 mm with zero gap provides adequate three-dimensional image quality on personal computer/laptop acquired by VR. It was especially helpful for assessment of lesions of the skull base, intracranial vessels (aneurysm and arteriovenous malformation), craniovertebral junction and contrast-enhancing lesions of the brain. Displaying VR images in the operating room as per the patient's head position orients the surgeon to identify various structures in the surgical field.

CONCLUSIONS

VR is underused in neurosurgery. It enables inexperienced neurosurgeons to understand morphologic details of a lesion and important osteoneurovascular structures around it. It is also helpful for training and preoperative planning in selected patients in neurosurgery.

Measurements and Clinical Application of Anatomical Space for Transfrontal Pituitary Surgery Through Magnetic Resonance Imaging Reconstruction

OBJECTIVE

This study aims to clarify the relative position of the normal important structures and anatomical spaces formed by the structures passed through during the transfrontal pituitary surgery, and discuss how to avoid some eloquent structures.

METHODS

A total of 120 cases of magnetic resonance imaging images from normal adult brains were selected as the object of study and divided into male and female groups. The important adjacent structures of the pituitary passed through during the transfrontal pituitary surgery were marked on the reconstructed images. In all planes of the spaces passing through successively during the pituitary surgery, the morphological parameters such as the size, boundary, structure, and spatial extent of the spaces were measured.

RESULTS

The size, boundary, structure, and spatial extent of the space between the 2 optic nerves, the space between the optic nerves and the pituitary stalk, and the space between the tuber cinereum and the interal carotid artery in the plane of the pituitary stalk were measured, the anterior part and the posterior part in male were shorter than those in female (P = 0.021; P = 0.029); no statistically significant difference was found in the measurements of the lengths and angles of these spaces.

CONCLUSIONS

The authors' findings provide the surgeons with the detailed anatomical data and help to provide a morphological basis for intraoperative protection of the pituitary and vital adjacent structures and surgical approach.