Virtual reality system for planning minimally invasive neurosurgery

Stadie, Axel; Kockro, Ralf A.; Reisch, Róbert; Tropine, Andrei; Boor, Stephan; Stoeter, P.; Perneczky, Axel

doi:10.3171/jns/2008/108/2/0382

Cited by 125 publications

(89 citation statements)

References 28 publications

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“…Three-dimensional virtual reality models of a patient allowed quick and easy understanding of complex intracranial lesions. 7,11 In cavernoma surgery a 3D virtual reality model enables the surgeon to preoperatively visualize the cortical surface with its gyral and sulcal patterns including the cortical vessels. A very precise image of what the surgeon will see after the craniotomy is created by the additional display of the skull and the skin.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive superficial temporal artery to middle cerebral artery bypass through a minicraniotomy: benefit of three-dimensional virtual reality planning using magnetic resonance angiography

Fischer

Stadie

Schwandt

et al. 2009

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Object The aim of the authors in this study was to introduce a minimally invasive superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery by the preselection of appropriate donor and recipient branches in a 3D virtual reality setting based on 3-T MR angiography data. Methods An STA-MCA anastomosis was performed in each of 5 patients. Before surgery, 3-T MR imaging was performed with 3D magnetization-prepared rapid acquisition gradient echo sequences, and a high-resolution CT 3D dataset was obtained. Image fusion and the construction of a 3D virtual reality model of each patient were completed. Results In the 3D virtual reality setting, the skin surface, skull surface, and extra- and intracranial arteries as well as the cortical brain surface could be displayed in detail. The surgical approach was successfully visualized in virtual reality. The anatomical relationship of structures of interest could be evaluated based on different values of translucency in all cases. The closest point of the appropriate donor branch of the STA and the most suitable recipient M3 or M4 segment could be calculated with high accuracy preoperatively and determined as the center point of the following minicraniotomy. Localization of the craniotomy and the skin incision on top of the STA branch was calculated with the system, and these data were transferred onto the patient's skin before surgery. In all cases the preselected arteries could be found intraoperatively in exact agreement with the preoperative planning data. Successful extracranial-intracranial bypass surgery was achieved without stereotactic neuronavigation via a preselected minimally invasive approach in all cases. Subsequent enlargement of the craniotomy was not necessary. Perioperative complications were not observed. All bypasses remained patent on follow-up. Conclusions With the application of a 3D virtual reality planning system, the extent of skin incision and tissue trauma as well as the size of the bone flap was minimal. The closest point of the appropriate donor branch of the STA and the most suitable recipient M3 or M4 segment could be preoperatively determined with high accuracy so that the STA-MCA bypass could be safely and effectively performed through an optimally located minicraniotomy with a mean diameter of 22 mm without the need for stereotactic guidance.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive superficial temporal artery to middle cerebral artery bypass through a minicraniotomy: benefit of three-dimensional virtual reality planning using magnetic resonance angiography

Fischer

Stadie

Schwandt

et al. 2009

FOC

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“…The extent of tissue displacement in ETVs has been quantified by several investigators using intraoperative neuronavigation and paralleled with clinical safety of the procedure [14,16,17,24]. Furthermore, several studies advocate surgical simulation that uses virtual platforms or physical heads as adjunct models of surgical training as well as preoperative planning [25][26][27]. Given above, there is an emerging methodological trend towards using radioanatomical simulations to incorporate individual anatomical characteristics in surgical planning as well as training.…”

Section: Radioanatomical Simulations Of Surgical Approachesmentioning

confidence: 99%

Operative planning aid for optimal endoscopic third ventriculostomy entry points in pediatric cases

et al. 2017

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Object Endoscopic third ventriculostomy (ETV) uses anatomical spaces of the ventricular system to reach the third ventricle floor and create an alternative pathway for cerebrospinal fluid flow. Optimal ETV trajectories have been previously proposed in the literature, designed to grant access to the third ventricle floor without a displacement of eloquent periventricular structures. However, in hydrocephalus, there is a significant variability to the configuration of the ventricular system, implying that the optimal ETV trajectory and cranial entry point needs to be planned on a case-by-case basis. In the current study, we created a mathematical model, which tailors the optimal ETV entry point to the individual case by incorporating the ventricle dimensions. Methods We retrospectively reviewed the imaging of 30 consecutive pediatric patients with varying degrees of ventriculomegaly. Three dimensional radioanatomical models were created using preoperative MRI scans to simulate the optimal ETV trajectory and entry point for each case. The surface location of cranial entry points for individual ETV trajectories was recorded as Cartesian coordinates centered at Bregma. The distance from the Bregma in the coronal plane represented as Bx^, and the distance from the coronal suture in the sagittal plane represented as By^. The correlation between the ventricle dimensions and the x, y coordinates were tested using linear regression models. Results The distance of the optimal ETV entry point from the Bregma in the coronal plane (Bx^) and from the coronal suture in the sagittal plane (By^) correlated well with the frontal horn ratio (FHR). The coordinates for x and y were fitted along the following linear equations: x = 85.8 FHR−13.3 (r 2 = 0.84, p < 0.001) and y = −69.6 FHR + 16.7 (r 2 = 0.83, p < 0.001). Conclusion The surface location of the optimal cranial ETV entry point correlates well with the ventricle size. We provide the first model that can be used as a surgical planning aid for a case specific ETV entry site with the incorporation of the ventricle size.

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“…Vários trabalhos verificados na literatura utilizaram a estereoscopia com múltiplos propósitos: de ensino 1-8 ; treinamento [9][10][11][12][13][14][15] ; planejamento operatório [16][17][18][19][20][21] ; tratamento [22][23][24][25][26][27] e documentação. [28][29][30] Considerou-se, neste trabalho, a estereoscopia como componente essencial dos ambientes de realidade virtual (RV).…”

Section: Início E Evolução Do Conhecimento Da Neuroanatomia E Utilizaunclassified

“…11,12,39,40 A RV também já é citada como uma ferramenta no processo de planejamento operatório. 13,[16][17][18][19][20][21]24,[41][42][43][44][45] A planificação de ato operató-rio por cirurgião experiente e a compreensão do que se fará, por parte do aprendiz, utilizando-se métodos visuais atrativos, principalmente se aliados à estereoscopia, podem fornecer meio preciso e rápido de aprendizado. A RV se presta a planificar operações de modo a utilizar melhores ângulos de vista com menor risco para o paciente.…”

Section: Realidade Virtual: Início E Emprego Em Neuroanatomia E Neurounclassified

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Virtual reality system for planning minimally invasive neurosurgery

Cited by 125 publications

References 28 publications

Minimally invasive superficial temporal artery to middle cerebral artery bypass through a minicraniotomy: benefit of three-dimensional virtual reality planning using magnetic resonance angiography

Minimally invasive superficial temporal artery to middle cerebral artery bypass through a minicraniotomy: benefit of three-dimensional virtual reality planning using magnetic resonance angiography

Operative planning aid for optimal endoscopic third ventriculostomy entry points in pediatric cases

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