Simulation of surgery for supratentorial gliomas in virtual reality using a 3D volume rendering technique: a poor man's neuronavigation

Abstract

OBJECTIVE Different techniques of performing image-guided neurosurgery exist, namely, neuronavigation systems, intraoperative ultrasound, and intraoperative MRI, each with its limitations. Except for ultrasound, other methods are expensive. Three-dimensional virtual reconstruction and surgical simulation using 3D volume rendering (VR) is an economical and excellent technique for preoperative surgical planning and image-guided neurosurgery. In this article, the authors discuss several nuances of the 3D VR technique that have not yet been described. METHODS The authors included 6 patients with supratentorial gliomas who underwent surgery between January 2019 and March 2021. Preoperative clinical data, including patient demographics, preoperative planning details (done using the VR technique), and intraoperative details, including relevant photos and videos, were collected. RadiAnt software was used for generating virtual 3D images using the VR technique on a computer running Microsoft Windows. RESULTS The 3D VR technique assists in glioma surgery with a preoperative simulation of the skin incision and craniotomy, virtual cortical surface marking and navigation for deep-seated gliomas, preoperative visualization of morbid cortical surface and venous anatomy in surfacing gliomas, identifying the intervenous surgical corridor in both surfacing and deep-seated gliomas, and pre- and postoperative virtual 3D images highlighting the exact spatial geometric residual tumor location and extent of resection for low-grade gliomas (LGGs). CONCLUSIONS Image-guided neurosurgery with the 3D VR technique using RadiAnt software is an economical, easy-to-learn, and user-friendly method of simulating glioma surgery, especially in resource-constrained countries where expensive neuronavigation systems are not readily available. Apart from cortical sulci/gyri anatomy, FLAIR sequences are ideal for the 3D visualization of nonenhancing diffuse LGGs using the VR technique. In addition to cortical vessels (especially veins), contrast MRI sequences are perfect for the 3D visualization of contrast-enhancing high-grade gliomas.

Use of cost-effective software for lesion localization in brain surgery: Technical note

“…Authors have been using radiant DICOM software for the last many years for spine, craniovertebral junction, neurovascular, and neurooncological surgeries. [ 8 , 11 , 12 ] Readers may also refer to the report, which describes the technique for using this software. [ 8 ]…”

“…Deep-seated contrast-enhancing lesions can be localized using this technique, which has been reported by the senior author. [ 11 ] This report focuses mainly on non-contrast enhancing lesions, especially over the cortical surface. The technique can be used for deeper lesions too using the 3D T2 FLAIR sequence where scalp incision, craniotomy, and entry point over the gyrus/ sulcus along with the trajectory can be decided.…”

The role of extended reality in eloquent area lesions: a systematic review

“…In 1 study (33.3%), intraoperative VR tasks were used for brain mapping during awake surgery; 72 in the other 2 (66.7%), VR techniques were used for preoperative 3D knowledge of the cortical and venous anatomy. 63,70 This table shows all the studies included in this systematic review, focusing on type of study, age, sex, neurological status before surgery, histology, lesion and side location, surgical approach surgery (i.e., awake or under general anesthesia), postoperative outcome, type of additional instrumentations/extended reality used (mixed reality/VR/AR), and their role in the procedure.…”