3D segmentation for neurosurgical preoperative planning: case series report

Abstract

Background: In Neurosurgery, 3D technology has emerged as a technique with the potential to provide detailed information on the threedimensional orientation of objects within the surgical site before surgery. These models can be used for preoperative planning, such as finding the best cranial approach and avoiding eloquent areas of the brain. The aim of the study was to determine the impact of 3D technology on neurosurgery development. Material and methods: Fused MRI and Angio-CT images of 6 patients, treated in the Institute of Neurology and Neurosurgery, with various cerebrovascular diseases were used. Their final images were used for picture reconstruction, 3D segmentation, which were eventually used for planning of the optimal surgical approach. Results: A detailed technique for picture acquisition, 3D reconstruction and visualization of the clinical cases was reported. For 2 patients with brain tumors, the 3D models were exported in Virtual Reality environment to choose most optimal approach by avoiding eloquent areas. In other 2 patients with brain aneurysm, the 3D their cerebral vessels were printed to acquire its real sizes and most optimal clipping sizes and angles. For last 2 patients with skull defects, special molds were 3D printed for creating symmetrical implant, to avoid modeling them by hand. Conclusions: The case series prove that using 3D technology in neurosurgical planning shortens the length of surgery, offers more flexible surgical approaches with less intra- and postoperative complications and serves as perfect environment for teaching younger neurosurgeons and residents advanced neurosurgical techniques.