Zdravniški Vestnik (Nov 2006)
Computer assisted pre-operative interactive 3-d planning of surgical procedures in neurosurgery
Abstract
Background: Present paper describes our experiences with the use of three-dimensional (3D) reconstruction of medical images for pre-operative planning and intra-operative navigation in neurosurgery of cortical and sub-cortical tumors.Methods: In 10 patients with cortical and sub-cortical tumors, before surgery 3D models of tumor, normal nearby brain tissue and cortical veins were reconstructed from magnetic resonance images and in selected cases functional magnetic resonance images using the computer program »3D Slicer«. Based on these models, the skin incision, trepanation opening and trans-cortical approach to the tumor were planned in virtual 3D computer space. Collected positional data were transferred from the 3D computer space to the operation field using distances from the artificial and typical anatomical landmarks on skin and cortical surface.Results: Computer assisted 3D reconstruction provided a surgeon with more accurate localization of tumor than conventional mental reconstruction of the 2D medical images. In all cases the position, size and shape of skin incision, trepanation opening, cortical veins, sulci and gyri visualized on computer screen before surgery matched the actual anatomy observed during surgical procedure. In all patients the lesion was precisely found and macroscopically totally resected with minimal injury to the adjacent normal structures.Conclusions: Pre-operative computer assisted 3D reconstruction provides important additional information about spatial localization of cortical and sub-cortical tumors in comparison to mental reconstruction of 2D medical images. Therefore, it improves the accuracy of planning the surgical procedure and makes it less invasive and less risky.
