存在执行图像引导神经外科手术的不同技术,即,神经导航系统,术中超声,术中MRI,每一个都有其局限性。除了超声波,其他方法很昂贵。使用3D体积渲染(VR)进行三维虚拟重建和手术仿真是一种经济且出色的术前手术计划和图像引导神经外科手术技术。在这篇文章中,作者讨论了尚未描述的3DVR技术的几个细微差别。
作者纳入了6例幕上胶质瘤患者,他们在2019年1月至2021年3月期间接受了手术。术前临床资料,包括病人的人口统计,术前计划细节(使用VR技术完成),术中细节,包括相关的照片和视频,被收集。RadiAnt软件用于在运行MicrosoftWindows的计算机上使用VR技术生成虚拟3D图像。
3DVR技术通过术前模拟皮肤切口和开颅手术来协助神经胶质瘤手术,深部胶质瘤的虚拟皮质表面标记和导航,表面胶质瘤病态皮质表面和静脉解剖的术前可视化,确定表面和深层胶质瘤的介入手术走廊,以及术前和术后虚拟3D图像,突出显示低级别胶质瘤(LGG)的确切空间几何残留肿瘤位置和切除范围。
使用RadiAnt软件的3DVR技术进行图像引导的神经外科手术是一种经济,简单易学,和用户友好的模拟神经胶质瘤手术的方法,特别是在资源有限的国家,昂贵的神经导航系统是不容易得到的。除了皮质沟/回旋解剖,FLAIR序列是使用VR技术对非增强弥漫性LGG进行3D可视化的理想选择。除了皮质血管(尤其是静脉),对比MRI序列是完美的三维可视化的对比增强高级别胶质瘤。
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.
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.
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).
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.