Institutional members access full text with Ovid®

Brain Tumor Surgery With 3-Dimensional Surface Navigation

Mert, Ayguel MD*; Buehler, Katja PhD; Sutherland, Garnette R. MD§; Tomanek, Boguslaw PhD; Widhalm, Georg MD*; Kasprian, Gregor MD; Knosp, Engelbert MD*; Wolfsberger, Stefan MD*,§

doi: 10.1227/NEU.0b013e31826a8a75
Technique Assessment

BACKGROUND: Precise lesion localization is necessary for neurosurgical procedures not only during the operative approach, but also during the preoperative planning phase.

OBJECTIVE: To evaluate the advantages of 3-dimensional (3-D) brain surface visualization over conventional 2-dimensional (2-D) magnetic resonance images for surgical planning and intraoperative guidance in brain tumor surgery.

METHODS: Preoperative 3-D brain surface visualization was performed with neurosurgical planning software in 77 cases (58 gliomas, 7 cavernomas, 6 meningiomas, and 6 metastasis). Direct intraoperative navigation on the 3-D brain surface was additionally performed in the last 20 cases with a neurosurgical navigation system. For brain surface reconstruction, patient-specific anatomy was obtained from MR imaging and brain volume was extracted with skull stripping or watershed algorithms, respectively. Three-dimensional visualization was performed by direct volume rendering in both systems. To assess the value of 3-D brain surface visualization for topographic lesion localization, a multiple-choice test was developed. To assess accuracy and reliability of 3-D brain surface visualization for intraoperative orientation, we topographically correlated superficial vessels and gyral anatomy on 3-D brain models with intraoperative images.

RESULTS: The rate of correct lesion localization with 3-D was significantly higher (P = .001, χ2), while being significantly less time consuming (P < .001, χ2) compared with 2-D images. Intraoperatively, visual correlation was found between the 3-D images, superficial vessels, and gyral anatomy.

CONCLUSION: The proposed method of 3-D brain surface visualization is fast, clinically reliable for preoperative anatomic lesion localization and patient-specific planning, and, together with navigation, improves intraoperative orientation in brain tumor surgery and is relatively independent of brain shift.

*Department of Neurosurgery, Medical University Vienna, Vienna, Austria

VRVis Research Center for Virtual Reality and Visualization GmbH, Vienna, Austria

§Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada

Institute for Biodiagnostics (West), National Research Council, Calgary, Alberta, Canada

Division of Neuroradiology of the Department of Radiology, Medical University Vienna, Vienna, Austria

Correspondence: Stefan Wolfsberger, MD, Department of Neurosurgery, Medical University Vienna – General Hospital (AKH), Waehringer Guertel 18-20, 1097 Vienna, Austria. E-mail:

Received April 03, 2012

Accepted July 05, 2012

Copyright © by the Congress of Neurological Surgeons