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

Abstract

S urgical removal of tumors located in the skull base or deep intracranial regions requires a high order of anatomical knowledge that can be obtained only through a large number of surgical experiences and has therefore been recognized as a challenging category in the neurosurgical field. Object. In this paper, the authors' goal was to report their novel presurgical simulation method applying interactive virtual simulation (IVS) using 3D computer graphics (CG) data and microscopic observation of color-printed plaster models based on these CG data in surgery for skull base and deep tumors.Methods. For 25 operations in 23 patients with skull base or deep intracranial tumors (meningiomas, schwannomas, epidermoid tumors, chordomas, and others), the authors carried out presurgical simulation based on 3D CG data created by image analysis for radiological data. Interactive virtual simulation was performed by modifying the 3D CG data to imitate various surgical procedures, such as bone drilling, brain retraction, and tumor removal, with manipulation of a haptic device. The authors also produced color-printed plaster models of modified 3D CG data by a selective laser sintering method and observed them under the operative microscope.Results. In all patients, IVS provided detailed and realistic surgical perspectives of sufficient quality, thereby allowing surgeons to determine an appropriate and feasible surgical approach. Surgeons agreed that in 44% of the 25 operations IVS showed high utility (as indicated by a rating of "prominent") in comprehending 3D microsurgical anatomies for which reconstruction using only 2D images was complicated. Microscopic observation of color-printed plaster models in 12 patients provided further utility in confirming realistic surgical anatomies.Conclusions. The authors' presurgical simulation method applying advanced 3D imaging and modeling techniques provided a realistic environment for practicing microsurgical procedures virtually and enabled the authors to ascertain complex microsurgical anatomy, to determine the optimal surgical strategies, and also to efficiently educate neurosurgical trainees, especially during surgery for skull base and deep tumors. (http://thejns.org/doi/abs/10.3171/2013.3.JNS121109) keY WorDs • neurosurgery • presurgical simulation • skull base tumor • surgical anatomy • 3D imaging • oncology Abbreviations used in this paper: CAD = computer-aided designing; CG = computer graphics; CN = cranial nerve; CPA = cerebellopontine angle; CTA = CT angiography; DSA = digital subtraction angiography; IAC = internal auditory canal; IVS = interactive virtual simulation; MRA = MR angiography.

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