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Isikay I, Cekic E, Baylarov B, Tunc O, Hanalioglu S. Narrative review of patient-specific 3D visualization and reality technologies in skull base neurosurgery: enhancements in surgical training, planning, and navigation. Front Surg 2024; 11:1427844. [PMID: 39081485 PMCID: PMC11287220 DOI: 10.3389/fsurg.2024.1427844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/02/2024] [Indexed: 08/02/2024] Open
Abstract
Recent advances in medical imaging, computer vision, 3-dimensional (3D) modeling, and artificial intelligence (AI) integrated technologies paved the way for generating patient-specific, realistic 3D visualization of pathological anatomy in neurosurgical conditions. Immersive surgical simulations through augmented reality (AR), virtual reality (VR), mixed reality (MxR), extended reality (XR), and 3D printing applications further increased their utilization in current surgical practice and training. This narrative review investigates state-of-the-art studies, the limitations of these technologies, and future directions for them in the field of skull base surgery. We begin with a methodology summary to create accurate 3D models customized for each patient by combining several imaging modalities. Then, we explore how these models are employed in surgical planning simulations and real-time navigation systems in surgical procedures involving the anterior, middle, and posterior cranial skull bases, including endoscopic and open microsurgical operations. We also evaluate their influence on surgical decision-making, performance, and education. Accumulating evidence demonstrates that these technologies can enhance the visibility of the neuroanatomical structures situated at the cranial base and assist surgeons in preoperative planning and intraoperative navigation, thus showing great potential to improve surgical results and reduce complications. Maximum effectiveness can be achieved in approach selection, patient positioning, craniotomy placement, anti-target avoidance, and comprehension of spatial interrelationships of neurovascular structures. Finally, we present the obstacles and possible future paths for the broader implementation of these groundbreaking methods in neurosurgery, highlighting the importance of ongoing technological advancements and interdisciplinary collaboration to improve the accuracy and usefulness of 3D visualization and reality technologies in skull base surgeries.
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Affiliation(s)
- Ilkay Isikay
- Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Efecan Cekic
- Neurosurgery Clinic, Polatli Duatepe State Hospital, Ankara, Türkiye
| | - Baylar Baylarov
- Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Osman Tunc
- Btech Innovation, METU Technopark, Ankara, Türkiye
| | - Sahin Hanalioglu
- Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
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Utility of multi-material three-dimensional print model in preoperative simulation for glioma surgery. J Clin Neurosci 2021; 93:200-205. [PMID: 34656248 DOI: 10.1016/j.jocn.2021.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/11/2021] [Accepted: 09/07/2021] [Indexed: 11/22/2022]
Abstract
Although the three-dimensional (3D) printing technology has spread in the field of neurosurgery, the use of 3D print models concerning glioma surgery has rarely reported. For glioma surgery, some preoperative and intraoperative assistive methods have been developed to avoid injury to the cortex and fiber that are related to the neurological function. Furthermore, in order to perform preoperative simulation of glioma surgery, we created a 3D print model using a multi-material 3D printer that provided the flexibility of adjusting the color, hardness, and translucency of each structure arbitrarily. The use of 3D print model was demonstrated in one case involving an intramedullary tumor in the right temporal lobe. The tumor, optic radiation, brain parenchyma, tentorium, ventricle, and sinus were constructed in a single model in one printing process. Design of the degree of resection, insertion of the fence-post, and tumor resection paying attention to the optic radiation were simulated preoperatively using this model. The surgery was performed generally as the simulation and gross total removal of the tumor was achieved. This model was useful for understanding the degree of resection, adequate insertion of the fence-post, and the relationship of the tumor with other important structures. A variety of printing materials contributed to make the model realistic and to understand anatomical relationship. In conclusion, the 3D print model can supplement an image of some portions that are not visible perioperatively and serve as a preoperative assistant modality.
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Zawy Alsofy S, Welzel Saravia H, Nakamura M, Ewelt C, Lewitz M, Sakellaropoulou I, Sarkis HM, Fortmann T, Schipmann S, Suero Molina E, Santacroce A, Salma A, Stroop R. Virtual reality-based evaluation of neurovascular conflict for the surgical planning of microvascular decompression in trigeminal neuralgia patients. Neurosurg Rev 2021; 44:3309-3321. [PMID: 33586035 DOI: 10.1007/s10143-021-01500-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/13/2020] [Accepted: 02/08/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is a lightning bolt of violent, electrifying, and stinging pain, often secondary to the neurovascular conflict (NVC). The vessels involved in NVC are mostly arteries and rarely veins. Evaluation of NVC in the deep infratentorial region is inseparably connected with cranial imaging. We retrospectively analyzed the potential influence of three-dimensional (3D) virtual reality (VR) reconstructions compared to conventional magnetic resonance imaging (MRI) scans on the evaluation of NVC for the surgical planning of microvascular decompression in patients with TN. METHODS Medical files were retrospectively analyzed regarding patient- and disease-related data. Preoperative MRI scans were retrospectively visualized via VR software to detect the characteristics of NVC. A questionnaire of experienced neurosurgeons evaluated the influence of VR visualization technique on identification of anatomical structures involved in NVC and on surgical strategy. RESULTS Twenty-four patients were included and 480 answer sheets were evaluated. Compared to conventional MRI, image presentation using 3D-VR modality significantly influenced the identification of the affected trigeminal nerve (p = 0.004), the vascular structure involved in the NVC (p = 0.0002), and the affected side of the trigeminal nerve (p = 0.005). CONCLUSIONS In patients with TN caused by NVC, the reconstruction of conventional preoperative MRI scans and the spatial and anatomical presentation in 3D-VR models offers the possibility of increased understanding of the anatomy and even more the underlying pathology, and thus influences operation planning and strategy.
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Affiliation(s)
- Samer Zawy Alsofy
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany. .,Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany.
| | - Heinz Welzel Saravia
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Makoto Nakamura
- Department of Neurosurgery, Academic Hospital Köln-Merheim, Witten/Herdecke University, Köln, Germany
| | - Christian Ewelt
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Marc Lewitz
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Ioanna Sakellaropoulou
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Hraq Mourad Sarkis
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Thomas Fortmann
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | | | - Eric Suero Molina
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Antonio Santacroce
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany.,Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Germany
| | - Asem Salma
- Department of Neurosurgery, St. Rita's Neuroscience Institute, Lima, Ohio, USA
| | - Ralf Stroop
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Cerebral Anatomy Detection and Surgical Planning in Patients with Anterior Skull Base Meningiomas Using a Virtual Reality Technique. J Clin Med 2021; 10:jcm10040681. [PMID: 33578799 PMCID: PMC7916569 DOI: 10.3390/jcm10040681] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/20/2021] [Accepted: 02/07/2021] [Indexed: 12/02/2022] Open
Abstract
Anterior skull base meningiomas represent a wide cohort of tumors with different locations, extensions, configurations, and anatomical relationships. Diagnosis of these tumors and review of their therapies are inseparably connected with cranial imaging. We analyzed the influence of three-dimensional-virtual reality (3D-VR) reconstructions versus conventional computed tomography (CT) and magnetic resonance imaging (MRI) images (two-dimensional (2D) and screen 3D) on the identification of anatomical structures and on the surgical planning in patients with anterior skull base meningiomas. Medical files were retrospectively analyzed regarding patient- and disease-related data. Preoperative 2D-CT and 2D-MRI scans were retrospectively reconstructed to 3D-VR images and visualized via VR software to detect the characteristics of tumors. A questionnaire of experienced neurosurgeons evaluated the influence of the VR visualization technique on identification of tumor morphology and relevant anatomy and on surgical strategy. Thirty patients were included and 600 answer sheets were evaluated. The 3D-VR modality significantly influenced the detection of tumor-related anatomical structures (p = 0.002), recommended head positioning (p = 0.005), and surgical approach (p = 0.03). Therefore, the reconstruction of conventional preoperative 2D scans into 3D images and the spatial and anatomical presentation in VR models enabled greater understanding of anatomy and pathology, and thus influenced operation planning and strategy.
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Wang Z, Liang X, Yang Y, Gao B, Wang L, You W, Chen Z, Wang Z. A new scoring system for predicting extent of resection in medial sphenoid wing meningiomas based on three-dimensional multimodality fusion imaging. Chin Neurosurg J 2020; 6:35. [PMID: 33292782 PMCID: PMC7604967 DOI: 10.1186/s41016-020-00214-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Three-dimensional (3D) fusion imaging has been proved to be a promising neurosurgical tool for presurgical evaluation of tumor removal. We aim to develop a scoring system based on this new tool to predict the resection grade of medial sphenoid wing meningiomas (mSWM) intuitively. METHODS We included 46 patients treated for mSWM from 2014 to 2019 to evaluate their tumors' location, volume, cavernous sinus involvement, vascular encasement, and bone invasion by 3D multimodality fusion imaging. A scoring system based on the significant parameters detected by statistical analysis was created and evaluated. RESULTS The tumor volumes ranged from 0.8 cm3 to 171.9 cm3. A total of 39 (84.8%) patients had arterial involvement. Cavernous sinus (CS) involvement was observed in 23 patients (50.0%) and bone invasion was noted in 10 patients (21.7%). Simpson I resection was achieved in 10 patients (21.7%) and Simpson II resection was achieved in 17 patients (37.0%). Fifteen patients (32.6%) underwent Simpson III resection and 4 patients (8.7%) underwent Simpson IV resections. A scoring system was created. The score ranged from 1 to 10 and the mean score of our patients was 5.3 ± 2.8. Strong positive monotonic correlation existed between the score and resection grade (Rs = 0.772, P < 0.001). The scoring system had good predictive capacity with an accuracy of 69.60%. CONCLUSIONS We described a scoring system that enabled neurosurgeons to predict extent of resection and outcomes for mSWM preoperatively with 3D multimodality fusion imaging. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Zilan Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Xiaolong Liang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu Province, China
| | - Yanbo Yang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Bixi Gao
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Ling Wang
- Department of Radiology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, 215006, Jiangsu Province, China
| | - Wanchun You
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Zhouqing Chen
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
| | - Zhong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
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Guo XY, He ZQ, Duan H, Lin FH, Zhang GH, Zhang XH, Chen ZH, Sai K, Jiang XB, Wang ZN, Xie T, Chen ZP, Mou YG. The utility of 3-dimensional-printed models for skull base meningioma surgery. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:370. [PMID: 32355814 PMCID: PMC7186736 DOI: 10.21037/atm.2020.02.28] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Skull base meningioma surgery is often difficult and complicated to perform. Therefore, this study aims to investigate the effectiveness of 3-dimensional (3D)-printed models of skull base meningioma in the representation of anatomical structures, the simulation of surgical plans, and patient education on surgical outcomes. Methods A retrospective study of 35 patients (3D group: 19 patients and non-3D group: 16 patients) with skull base meningioma was conducted. Mimics software was used to create 3D reconstructions (with the skull, blood vessels, nerves, and tumors set to different colors), and 3D solid models were printed to determine the surgical protocols and communication pathways with the patient. Results The 3D-printed model can visually display the relationship of different structures, including the skull, blood vessels, cranial nerves, and tumors. The surgeon should select the proper surgical approaches before surgery through the model and pay attention to protecting the important structures during the operation. According to the models, the surgeon should cut off the blood supply to the tumor to reduce intraoperative bleeding. For patients with skull base bone destruction, the skull base repair should be prepared in advance. Patients and their families should have a thorough understanding of the disease through the model, and there should be effective communication between doctors and patients. Conclusions The 3D-printed model of a skull base meningioma can present the structures in a detailed manner and facilitate in helping the surgeon to develop a surgical plan. At the same time, it helps patients and their families to understand the condition and the surgical plan, which is conducive to better patient education.
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Affiliation(s)
- Xiao-Yu Guo
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510000, China
| | - Zhen-Qiang He
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510000, China
| | - Hao Duan
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510000, China
| | - Fu-Hua Lin
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510000, China
| | - Guan-Hua Zhang
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510000, China
| | - Xiang-Heng Zhang
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510000, China
| | - Zheng-He Chen
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510000, China
| | - Ke Sai
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510000, China
| | - Xiao-Bing Jiang
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510000, China
| | - Zhen-Ning Wang
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510000, China
| | - Tian Xie
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510000, China
| | - Zhong-Ping Chen
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510000, China
| | - Yong-Gao Mou
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510000, China
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Sato M, Tateishi K, Murata H, Kin T, Suenaga J, Takase H, Yoneyama T, Nishii T, Tateishi U, Yamamoto T, Saito N, Inoue T, Kawahara N. Three-dimensional multimodality fusion imaging as an educational and planning tool for deep-seated meningiomas. Br J Neurosurg 2018; 32:509-515. [PMID: 29943649 DOI: 10.1080/02688697.2018.1485877] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The utility of surgical simulation with three-dimensional multimodality fusion imaging (3D-MFI) has been demonstrated. However, its potential in deep-seated brain lesions remains unknown. The aim of this study was to investigate the impact of 3D-MFI in deep-seated meningioma operations. MATERIAL AND METHODS Fourteen patients with deeply located meningiomas were included in this study. We constructed 3D-MFIs by fusing high-resolution magnetic resonance (MR) and computed tomography (CT) images with a rotational digital subtraction angiogram (DSA) in all patients. The surgical procedure was simulated by 3D-MFI prior to operation. To assess the impact on neurosurgical education, the objective values of surgical simulation by 3D-MFIs/virtual reality (VR) video were evaluated. To validate the quality of 3D-MFIs, intraoperative findings were compared. The identification rate (IR) and positive predictive value (PPV) for the tumor feeding arteries and involved perforating arteries and veins were also assessed for quality assessment of 3D-MFI. RESULTS After surgical simulation by 3D-MFIs, near-total resection was achieved in 13 of 14 (92.9%) patients without neurological complications. 3D-MFIs significantly contributed to the understanding of surgical anatomy and optimal surgical view (p < .0001) and learning how to preserve critical vessels (p < .0001) and resect tumors safety and extensively (p < .0001) by neurosurgical residents/fellows. The IR of 3D-MFI for tumor-feeding arteries and perforating arteries and veins was 100% and 92.9%, respectively. The PPV of 3D-MFI for tumor-feeding arteries and perforating arteries and veins was 98.8% and 76.5%, respectively. CONCLUSIONS 3D-MFI contributed to learn skull base meningioma surgery. Also, 3D-MFI provided high quality to identify critical anatomical structures within or adjacent to deep-seated meningiomas. Thus, 3D-MFI is promising educational and surgical planning tool for meningiomas in deep-seated regions.
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Affiliation(s)
- Mitsuru Sato
- a Department of Neurosurgery, Graduate School of Medicine , Yokohama City University , Yokohama , Japan
| | - Kensuke Tateishi
- a Department of Neurosurgery, Graduate School of Medicine , Yokohama City University , Yokohama , Japan
| | - Hidetoshi Murata
- a Department of Neurosurgery, Graduate School of Medicine , Yokohama City University , Yokohama , Japan
| | - Taichi Kin
- b Department of Neurosurgery , The University of Tokyo Graduate School of Medicine , Tokyo , Japan
| | - Jun Suenaga
- a Department of Neurosurgery, Graduate School of Medicine , Yokohama City University , Yokohama , Japan
| | - Hajime Takase
- a Department of Neurosurgery, Graduate School of Medicine , Yokohama City University , Yokohama , Japan
| | - Tomohiro Yoneyama
- c Department of Radiology, Graduate School of Medicine , Yokohama City University , Yokohama , Japan
| | - Toshiaki Nishii
- c Department of Radiology, Graduate School of Medicine , Yokohama City University , Yokohama , Japan
| | - Ukihide Tateishi
- c Department of Radiology, Graduate School of Medicine , Yokohama City University , Yokohama , Japan.,d Department of Diagnostic Radiology, Graduate School of Medicine , Tokyo Medical and Dental University , Tokyo , Japan
| | - Tetsuya Yamamoto
- a Department of Neurosurgery, Graduate School of Medicine , Yokohama City University , Yokohama , Japan
| | - Nobuhito Saito
- b Department of Neurosurgery , The University of Tokyo Graduate School of Medicine , Tokyo , Japan
| | - Tomio Inoue
- c Department of Radiology, Graduate School of Medicine , Yokohama City University , Yokohama , Japan
| | - Nobutaka Kawahara
- a Department of Neurosurgery, Graduate School of Medicine , Yokohama City University , Yokohama , Japan
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Adachi K, Hasegawa M, Hirose Y. Evaluation of Venous Drainage Patterns for Skull Base Meningioma Surgery. Neurol Med Chir (Tokyo) 2017; 57:505-512. [PMID: 28579577 PMCID: PMC5638777 DOI: 10.2176/nmc.ra.2016-0336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The evaluation of venous drainage patterns prior to surgery for skull base meningioma is important owing to their deep location and the vulnerability of surrounding vascular structures. In recent years, the microsurgical skull base approach has matured as a surgical technique, making it an important option for reducing complications related to skull base meningioma surgery. In addition, knowledge of the venous anatomy can prevent venous drainage route disturbance and potentially life-threatening complications. Hence, this topic review aimed to provide an overview of normal venous anatomy as it relates to the microsurgical skull base approach, discuss known changes in venous drainage routes that are associated with the progression of skull base meningioma and the selection of an appropriate operative approach with the highest likelihood of preserving venous drainage structures.
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Affiliation(s)
- Kazuhide Adachi
- Department of Neurosurgery, School of Medicine, Fujita Health University
| | - Mitsuhiro Hasegawa
- Department of Neurosurgery, School of Medicine, Fujita Health University
| | - Yuichi Hirose
- Department of Neurosurgery, School of Medicine, Fujita Health University
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Spiriev T, Nakov V, Laleva L, Tzekov C. OsiriX software as a preoperative planning tool in cranial neurosurgery: A step-by-step guide for neurosurgical residents. Surg Neurol Int 2017; 8:241. [PMID: 29119039 PMCID: PMC5655755 DOI: 10.4103/sni.sni_419_16] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 06/06/2017] [Indexed: 01/18/2023] Open
Abstract
Background: OsiriX (Pixmeo, Switzerland) is an open-source Digital Imaging and Communications in Medicine (DICOM) viewer that is gaining more and more attention in the neurosurgical community because of its user-friendly interface, powerful three-dimensional (3D) volumetric rendering capabilities, and various options for data integration. This paper presents in detail the use of OsiriX software as a preoperative planning tool in cranial neurosurgery. Methods: In January 2013, OsiriX software was introduced into our clinical practice as a preoperative planning tool. Its capabilities are being evaluated on an ongoing basis in routine elective cranial cases. Results: The program has proven to be highly effective at volumetrically representing data from radiological examinations in 3D. Among its benefits in preoperative planning are simulating the position and exact location of the lesion in 3D, tailoring the skin incision and craniotomy bone flap, enhancing the representation of normal and pathological anatomy, and aiding in planning the reconstruction of the affected area. Conclusion: OsiriX is a useful tool for preoperative planning and visualization in neurosurgery. The software greatly facilitates the surgeon's understanding of the relationship between normal and pathological anatomy and can be used as a teaching tool.
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Affiliation(s)
- Toma Spiriev
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
| | - Vladimir Nakov
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
| | - Lili Laleva
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
| | - Christo Tzekov
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
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Kin T, Nakatomi H, Shono N, Nomura S, Saito T, Oyama H, Saito N. Neurosurgical Virtual Reality Simulation for Brain Tumor Using High-definition Computer Graphics: A Review of the Literature. Neurol Med Chir (Tokyo) 2017. [PMID: 28637947 PMCID: PMC5638778 DOI: 10.2176/nmc.ra.2016-0320] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Simulation and planning of surgery using a virtual reality model is becoming common with advances in computer technology. In this study, we conducted a literature search to find trends in virtual simulation of surgery for brain tumors. A MEDLINE search for “neurosurgery AND (simulation OR virtual reality)” retrieved a total of 1,298 articles published in the past 10 years. After eliminating studies designed solely for education and training purposes, 28 articles about the clinical application remained. The finding that the vast majority of the articles were about education and training rather than clinical applications suggests that several issues need be addressed for clinical application of surgical simulation. In addition, 10 of the 28 articles were from Japanese groups. In general, the 28 articles demonstrated clinical benefits of virtual surgical simulation. Simulation was particularly useful in better understanding complicated spatial relations of anatomical landmarks and in examining surgical approaches. In some studies, Virtual reality models were used on either surgical navigation system or augmented reality technology, which projects virtual reality images onto the operating field. Reported problems were difficulties in standardized, objective evaluation of surgical simulation systems; inability to respond to tissue deformation caused by surgical maneuvers; absence of the system functionality to reflect features of tissue (e.g., hardness and adhesion); and many problems with image processing. The amount of description about image processing tended to be insufficient, indicating that the level of evidence, risk of bias, precision, and reproducibility need to be addressed for further advances and ultimately for full clinical application.
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Affiliation(s)
- Taichi Kin
- Department of Neurosurgery, the University of Tokyo
| | | | | | - Seiji Nomura
- Department of Neurosurgery, the University of Tokyo
| | - Toki Saito
- Department of Clinical Information Engineering, the University of Tokyo Graduate School of Medicine
| | - Hiroshi Oyama
- Department of Clinical Information Engineering, the University of Tokyo Graduate School of Medicine
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Yoshino M, Saito T, Kin T, Nakagawa D, Nakatomi H, Oyama H, Saito N. A Microscopic Optically Tracking Navigation System That Uses High-resolution 3D Computer Graphics. Neurol Med Chir (Tokyo) 2015; 55:674-9. [PMID: 26226982 PMCID: PMC4628159 DOI: 10.2176/nmc.tn.2014-0278] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Three-dimensional (3D) computer graphics (CG) are useful for preoperative planning of neurosurgical operations. However, application of 3D CG to intraoperative navigation is not widespread because existing commercial operative navigation systems do not show 3D CG in sufficient detail. We have developed a microscopic optically tracking navigation system that uses high-resolution 3D CG. This article presents the technical details of our microscopic optically tracking navigation system. Our navigation system consists of three components: the operative microscope, registration, and the image display system. An optical tracker was attached to the microscope to monitor the position and attitude of the microscope in real time; point-pair registration was used to register the operation room coordinate system, and the image coordinate system; and the image display system showed the 3D CG image in the field-of-view of the microscope. Ten neurosurgeons (seven males, two females; mean age 32.9 years) participated in an experiment to assess the accuracy of this system using a phantom model. Accuracy of our system was compared with the commercial system. The 3D CG provided by the navigation system coincided well with the operative scene under the microscope. Target registration error for our system was 2.9 ± 1.9 mm. Our navigation system provides a clear image of the operation position and the surrounding structures. Systems like this may reduce intraoperative complications.
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Affiliation(s)
- Masanori Yoshino
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo
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Presurgical planning of feeder resection with realistic three-dimensional virtual operation field in patient with cerebellopontine angle meningioma. Acta Neurochir (Wien) 2013; 155:1391-9. [PMID: 23722311 DOI: 10.1007/s00701-013-1761-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND To devascularize meningiomas, the precise location of tumor attachment must be known. However, when a cerebellopontine angle (CPA) meningioma is in contact with many surrounding structures, it can be difficult to distinguish the most vascularized attachment (MVA) from other contact surfaces. OBJECTIVE To validate the usefulness of a virtual operation field (VOF) of a CPA meningioma by high-spatial-resolution three-dimensional computer graphics (hs-3DCG). METHODS Presurgical simulation with VOF was performed for eight CPA meningiomas to assess the MVA and the appropriate route to the main feeder. For hs-3DCG, the necessary preoperative radiographic images were fused. A hybrid model of volume and surface rendering was created from the fused images. The simulation results were compared with the operative results, and the MVA estimation rate was compared between VOF and contrast-enhanced fast imaging employing steady-state acquisition. RESULTS By using VOF, the point at which the main feeder penetrated the tumor was estimated in all cases, and using this information, the MVA was detected. All patients underwent resection of the main feeder in the same way as simulated preoperatively. Estimation rates of MVA were 37.5% in CE-FIESTA and 100% in VOF (p = 0.02, Fisher's exact test). CONCLUSION The hs-3DCG method was of sufficiently high quality to enable VOF of CPA meningioma. This method may facilitate estimation of MVA and the main feeder penetration point, and may aid in the determination of the most appropriate approach to the main feeder.
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Hiraishi T, Matsushima T, Kawashima M, Nakahara Y, Takahashi Y, Ito H, Oishi M, Fujii Y. 3D Computer graphics simulation to obtain optimal surgical exposure during microvascular decompression of the glossopharyngeal nerve. Neurosurg Rev 2013; 36:629-35; discussion 635. [PMID: 23771632 DOI: 10.1007/s10143-013-0479-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 01/01/2013] [Accepted: 03/10/2013] [Indexed: 12/01/2022]
Abstract
The affected artery in glossopharyngeal neuralgia (GPN) is most often the posterior inferior cerebellar artery (PICA) from the caudal side or the anterior inferior cerebellar artery (AICA) from the rostral side. This technical report describes two representative cases of GPN, one with PICA as the affected artery and the other with AICA, and demonstrates the optimal approach for each affected artery. We used 3D computer graphics (3D CG) simulation to consider the ideal transposition of the affected artery in any position and approach. Subsequently, we performed microvascular decompression (MVD) surgery based on this simulation. For PICA, we used the transcondylar fossa approach in the lateral recumbent position, very close to the prone position, with the patient's head tilted anteriorly for caudal transposition of PICA. In contrast, for AICA, we adopted a lateral suboccipital approach with opening of the lateral cerebellomedullary fissure, to visualize better the root entry zone of the glossopharyngeal nerve and to obtain a wide working space in the cerebellomedullary cistern, for rostral transposition of AICA. Both procedures were performed successfully. The best surgical approach for MVD in patients with GPN is contingent on the affected artery--PICA or AICA. 3D CG simulation provides tailored approach for MVD of the glossopharyngeal nerve, thereby ensuring optimal surgical exposure.
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Affiliation(s)
- Tetsuya Hiraishi
- Department of Neurosurgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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3D preoperative planning in the ER with OsiriX®: when there is no time for neuronavigation. SENSORS 2013; 13:6477-91. [PMID: 23681091 PMCID: PMC3690066 DOI: 10.3390/s130506477] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 05/01/2013] [Accepted: 05/08/2013] [Indexed: 11/23/2022]
Abstract
The evaluation of patients in the emergency room department (ER) through more accurate imaging methods such as computed tomography (CT) has revolutionized their assistance in the early 80s. However, despite technical improvements seen during the last decade, surgical planning in the ER has not followed the development of image acquisition methods. The authors present their experience with DICOM image processing as a navigation method in the ER. The authors present 18 patients treated in the Emergency Department of the Hospital das Clínicas of the University of Sao Paulo. All patients were submitted to volumetric CT. We present patients with epidural hematomas, acute/subacute subdural hematomas and contusional hematomas. Using a specific program to analyze images in DICOM format (OsiriX®), the authors performed the appropriate surgical planning. The use of 3D surgical planning made it possible to perform procedures more accurately and less invasively, enabling better postoperative outcomes. All sorts of neurosurgical emergency pathologies can be treated appropriately with no waste of time. The three-dimensional processing of images in the preoperative evaluation is easy and possible even within the emergency care. It should be used as a tool to reduce the surgical trauma and it may dispense methods of navigation in many cases.
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