A new strategic neurosurgical planning tool for brainstem cavernous malformations using interactive computer graphics with multimodal fusion images

Clinical article

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Object

In this study, the authors used preoperative simulation employing 3D computer graphics (interactive computer graphics) to fuse all imaging data for brainstem cavernous malformations. The authors evaluated whether interactive computer graphics or 2D imaging correlated better with the actual operative field, particularly in identifying a developmental venous anomaly (DVA).

Methods

The study population consisted of 10 patients scheduled for surgical treatment of brainstem cavernous malformations. Data from preoperative imaging (MRI, CT, and 3D rotational angiography) were automatically fused using a normalized mutual information method, and then reconstructed by a hybrid method combining surface rendering and volume rendering methods. With surface rendering, multimodality and multithreshold techniques for 1 tissue were applied. The completed interactive computer graphics were used for simulation of surgical approaches and assumed surgical fields. Preoperative diagnostic rates for a DVA associated with brainstem cavernous malformation were compared between conventional 2D imaging and interactive computer graphics employing receiver operating characteristic (ROC) analysis.

Results

The time required for reconstruction of 3D images was 3–6 hours for interactive computer graphics. Observation in interactive mode required approximately 15 minutes. Detailed anatomical information for operative procedures, from the craniotomy to microsurgical operations, could be visualized and simulated three-dimensionally as 1 computer graphic using interactive computer graphics. Virtual surgical views were consistent with actual operative views. This technique was very useful for examining various surgical approaches. Mean (± SEM) area under the ROC curve for rate of DVA diagnosis was significantly better for interactive computer graphics (1.000 ± 0.000) than for 2D imaging (0.766 ± 0.091; p < 0.001, Mann-Whitney U-test).

Conclusions

The authors report a new method for automatic registration of preoperative imaging data from CT, MRI, and 3D rotational angiography for reconstruction into 1 computer graphic. The diagnostic rate of DVA associated with brainstem cavernous malformation was significantly better using interactive computer graphics than with 2D images. Interactive computer graphics was also useful in helping to plan the surgical access corridor.

Abbreviations used in this paper:AUC = area under the curve; CST = corticospinal tract; DICOM = digital imaging and communication in medicine; DTI = diffusion-tensor imaging; DVA = developmental venous anomaly; FOV = field of view; MRA = MR angiography; ROC = receiver operating characteristic; TOF = time-of-flight; TRICKS = time-resolved imaging of contrast kinetics.
Article Information

Contributor Notes

Address correspondence to: Nobuhito Saito, M.D., Ph.D., Department of Neurosurgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. email: nsaito-tky@umin.net.Please include this information when citing this paper: published online May 11, 2012; DOI: 10.3171/2012.3.JNS111541.
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