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Presurgical Simulation With Advanced 3-Dimensional Multifusion Volumetric Imaging in Patients With Skull Base Tumors

Oishi, Makoto MD*; Fukuda, Masafumi MD*; Ishida, Go†; Saito, Akihiko MD*; Hiraishi, Tetsuya MD*; Fujii, Yukihiko MD*

doi: 10.1227/NEU.0b013e318207b3ad
Instrumentation Assessment: Editor's Choice

BACKGROUND: Despite recent diagnostic and technical advancements in the field of neurosurgery, surgical treatment for tumors in the skull base region, ie, skull base tumors (SBTs), remains a challenge.

OBJECTIVE: To validate the utility of presurgical simulation for the treatment of SBTs by 3-dimensional multifusion volumetric imaging (3D MFVI), including volume rendering and image fusion, to combine data from various imaging modalities.

METHODS: We performed presurgical simulation using 3D MFVI for 21 SBTs (acoustic neurinomas, jugular neurinomas, meningiomas, chordomas, and others) in 20 patients. We collected targeted data from computed tomography, magnetic resonance imaging, computed tomography or magnetic resonance angiography, and digital subtraction angiography and combined these data using image-analyzing software. The simulations were used to assess the 3D relationships among the microsurgical anatomical components, the appropriate surgical approach, and the resectable parts of the tumor. Finally, we compared the results of the simulation with the operative results.

RESULTS: In all patients, the 3D MFVI techniques enabled adequate visualization of the microsurgical anatomy and facilitated presurgical simulation, thereby allowing the surgeons to determine an appropriate and feasible surgical approach. All procedures to open the bone window were performed in accordance with the simulations, except for the surgical exposure of the acoustic canal for 2 acoustic neurinomas. In 3 of the 21 cases, tumor removal could not be performed according to the simulations because of unexpected bleeding or other restrictions.

CONCLUSION: The 3D MFVI technique was of a sufficiently high quality to enable visualization of the 3D microsurgical anatomy. This promising method can facilitate determination of the most appropriate approach and safe and precise surgical procedures for SBTs.

*Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan; †Department of Clinical Radiology, Shinjinkai Kita-Nihon No-Shinkei Geka Hospital, Niigata, Japan

Received, April 9, 2009.

Accepted, September 23, 2010.

Correspondence: Makoto Oishi, MD, Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachidori, Chuo-Ku, Niigata 951-8585, Japan. E-mail:

Copyright © by the Congress of Neurological Surgeons