Prediction of the Microsurgical Window for Skull-Base Tumors by Advanced Three-Dimensional Multi-fusion Volumetric Imaging

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.

Neurosurgical Virtual Reality Simulation for Brain Tumor Using High-definition Computer Graphics: A Review of the Literature

“…15–17,19,20) Using different combinations of original data according to the tissues of interest has become increasingly popular in recent years. 9,11,18,21) …”

“…14) Additionally, déjà vu experience during actual surgery, attributed to three-dimensional simulation, was thought to be useful. 21) …”

Interactive presurgical simulation applying advanced 3D imaging and modeling techniques for skull base and deep tumors

“…We previously reported on presurgical simulation using the 3D image-analysis method applying volumerendering and image fusion techniques, termed 3D multifusion volumetric imaging, for skull base tumors 16,17 or other neurosurgical entities. 18,19,25 Observation of 3D multifusion volumetric imaging improved our comprehension of the complicated anatomical relationships among the tumor, important vessels, the brain and CNs, and the skull in individual patients, but this analysis permitted only surveying 3D data from the outside without any interaction.…”

“…The original attempts to modify these models and to dissect them using surgical instruments have been reported in detail, especially for surgical simulation for skull base tumors. 13,14 We previously reported the value of 3D imaging techniques in neurosurgical planning, [16][17][18][19]25 and we recently established a novel surgical simulation style called interactive virtual simulation, 15 characterized by creating a patient-specific high-quality 3D CG data set from radiological data and then performing surgical simulation using unique CAD software with manipulation of a haptic device. In surgery for skull base or deep tumors, we performed IVS to create the best scenario for tumor removal and then used a 3D color printer to produce color plaster models with these surgical perspectives after IVS.…”

Usefulness of Preoperative Simulation in Skull Base Approach: A Case Report

“…The difficulty in approaching the skull base, complexity of the anatomy, location of the vital neurovascular structures, narrow surgical corridor, and longer operative time all render the skull base approach as a neurosurgical challenge. [1][2][3][4][5] The outcome of the skull base approach also depends upon the dexterity and the experience of the operating surgeon, and the learning curve for this approach is steep. Furthermore, the technical difficulty, stronger brain retraction required, and the distortion of the complex skull base anatomy by the tumor also impede the good postoperative outcome.…”