The 3D MFVI technique was of a sufficiently high quality to enable visualization of the 3D microsurgical anatomy. This promising method can facilitate determination of the most appropriate approach and safe and precise surgical procedures for SBTs.

No abstract

The surgery of skull base tumors (SBTs) is difficult due to the complex and narrow surgical window that is restricted by the cranium and important structures. The utility of three-dimensional multi-fusion volumetric imaging (3-D MFVI) for visualizing the predicted window for SBTs was evaluated. Presurgical simulation using 3-D MFVI was performed in 32 patients with SBTs. Imaging data were collected from computed tomography, magnetic resonance imaging, and digital subtraction angiography. Skull data was processed to imitate actual bone resection and integrated with various structures extracted from appropriate imaging modalities by image-analyzing software. The simulated views were compared with the views obtained during surgery. All craniotomies and bone resections except opening of the acoustic canal in 2 patients were performed as simulated. The simulated window allowed observation of the expected microsurgical anatomies including tumors, vasculatures, and cranial nerves, through the predicted operative window. We could not achieve the planned tumor removal in only 3 patients. 3-D MFVI afforded high quality images of the relevant microsurgical anatomies during the surgery of SBTs. The intraoperative déjà-vu effect of the simulation increased the confidence of the surgeon in the planned surgical procedures.

Presurgical VE in patients with trigeminal neuralgia or HFS is a novel technique that provides excellent visualization of the three-dimensional relations between neurovascular structures and allows simulation of MVD.