Background: Presurgical three-dimensional (3D) reconstructions allow spatial localization of cerebral lesions and their relationship with adjacent anatomical structures for optimal surgical resolution. The purpose of the present article is to present a method of virtual preoperative planning aiming to enhance 3D comprehension of neurosurgical pathologies using free DICOM image viewers. Case Description: We describe the virtual presurgical planning of a 61-year-old female presenting a cerebral tumor. 3D reconstructions were created with the “Horos®” Digital Imaging and Communications in Medicine viewer, utilizing images obtained from contrast-enhanced brain magnetic resonance imaging and computed tomography. The tumor and adjacent relevant structures were identified and delimited. A sequential virtual simulation of the surgical stages for the approach was performed with the identification of local gyral and vascular patterns of the cerebral surface for posterior intraoperative recognition. Through virtual simulation, an optimal approach was gained. Accurate localization and complete removal of the lesion were achieved during the surgical procedure. Virtual presurgical planning with open-source software can be utilized for supratentorial pathologies in both urgent and elective cases. Virtual recognition of vascular and cerebral gyral patterns is helpful reference points for intraoperative localization of lesions lacking cortical expression, allowing less invasive corticotomies. Conclusion: Digital manipulation of cerebral structures can increase anatomical comprehension of neurosurgical lesions to be treated. 3D interpretation of neurosurgical pathologies and adjacent anatomical structures is essential for developing an effective and safe surgical approach. The described technique is a feasible and accessible option for presurgical planning.
Introducción: Los quistes epidermoides intradiploicos representan el 25% de los tumores epidermoides intracraneales y menos del 0,25% de todos los tumores intracraneales primarios. El hueso frontal y el parietal son las localizaciones más comunes. La extensión intradural es muy infrecuente, representando solamente el 3% del total de ellos. Caso clínico: Paciente femenina de 64 años con antecedente de TEC frontal a los 11 años de edad consulta por una tumoración subcutánea de 5 x 4 cm a nivel frontal izquierda de evolución prolongada. TC de encéfalo mostró una lesión lítica de calota asociada a compromiso subgaleal, invasión intradural y extensión intraparenquimatosa. Se decidió la conducta quirúrgica con exéresis de la misma junto con su pseudocápsula. El informe anatomopatológico reveló quiste epidermoide. Discusión: Los quistes epidermoides pueden ser congénitos o adquiridos. Al igual que nuestro caso, los adquiridos suelen causarse por la inclusión traumática del epitelio superficial. Suelen presentarse como una tumefacción subcutánea y permanecer asintomáticos hasta incluso décadas. La inusual extensión intradural puede generar síntomas tales como convulsiones y déficits neurológicos. El tratamiento suele ser la exéresis completa junto con su capsula para así lograr un pronóstico favorable y la prevención de complicaciones. Conclusión: Los quistes epidermoides intradiploicos son lesiones benignas y de crecimiento lento, pudiendo alcanzar tamaños considerables y ocasionalmente extenderse intracranealmente. El diagnóstico suele sospecharse radiológicamente y es confirmado mediante el estudio anatomopatológico. Deben incluirse dentro del algoritmo diagnóstico en pacientes que presentan lesiones únicas de calota con osteólisis e invasión intradural. En casos de extensión intradural, se insiste en su extirpación total con el fin prevenir la recurrencia y su potencial malignización.
There is evidence of association between sellar barrier thickness and intraoperative cerebrospinal fluid (CSF) leakage, impacting the postoperative prognosis of the patients. The aim of this study is to analyze the clinical applicability of the sellar barrier concept in a series of operated patients with pituitary apoplexy (PA). A retrospective study was conducted including 47 patients diagnosed with PA who underwent surgical treatment through a transsphenoidal approach. Brain magnetic resonance imaging (MRI) of the patients were evaluated and classified utilizing the following criteria: strong barrier (greater than 1 mm), weak barrier (less than 1 mm), and mixed barrier (less than 1 mm in one area and greater than 1 mm in another). The association between sellar barrier types and CSF leakage was analyzed, both pre- and intraoperatively. The preoperative MRI classification identified 10 (21.28%) patients presenting a weak sellar barrier, 20 patients (42.55%) with a mixed sellar barrier, and 17 patients (36.17%) exhibiting a strong sellar barrier. Preoperative weak and strong sellar barrier subtypes were associated with weak (p ≤ 0.001) and strong (p = 0.009) intraoperative sellar barriers, respectively. Strong intraoperative sellar barrier subtypes reduced the odds of CSF leakage by 86% (p = 0.01). A correlation between preoperative imaging and intraoperative findings in the setting of pituitary apoplexy has been observed.
Background: Most neurosurgical photographs are limited to two-dimensional (2D), in this sense, most teaching and learning of neuroanatomical structures occur without an appreciation of depth. The objective of this article is to describe a simple technique for obtaining right and left 2D endoscopic images with manual angulation of the optic. Methods: The implementation of a three-dimensional (3D) endoscopic image technique is reported. We first describe the background and core principles related to the methods employed. Photographs are taken demonstrating the principles and also during an endoscopic endonasal approach, illustrating the technique. Later, we divide our process into two sections containing explanations, illustrations, and descriptions. Results: The results of taking a photograph with an endoscope and its assembly to a 3D image has been divided into two parts: Photo acquisition and image processing. Conclusion: We conclude that the proposed method is successful in producing 3D endoscopic images.
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