Frameless Nonstereotactic Image-Guided Surgery of Supratentorial Lesions: Introduction to a Safe and Inexpensive Technique
Frameless Nonstereotactic Image-Guided Surgery of Supratentorial Lesions: Introduction to a Safe and Inexpensive Technique
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DOI：
10.1055/s-0033-1358607
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发表时间：
2014-09-01
影响因子：
1
通讯作者：
Gazzeri, Roberto
中科院分区：
文献类型：
--
作者：
Callovini, Giorgio;Sherkat, Shahram;Gazzeri, Roberto
背景我们描述了一种简单、安全和廉价的技术，通过将三维(3D)磁共振(MR)图像与真实解剖学进行比较，我们可以通过直接识别解剖标志来导航和移除大脑病变，包括那些没有皮质外观的病变。术前计划不再需要使用基准，因此可以进行立体定向设置。方法使用MRIcro免费软件对93例患者的MR数字成像和医学通信格式扫描进行三维重建(3DR)。病变部位多为颞叶或左侧，多无皮质征象(78%)。该软件对二维(2D)图像集进行3DR处理，从而获得患者头部的虚拟模型。使用相同的2D集，病变图像的边缘由感兴趣区域(ROI)工具勾画出来。在下一步中，将感兴趣区域投影到患者头部虚拟模型的表面上，从而帮助实现对开颅手术区域的最佳识别。脑提取工具(BET)的MRIcro自动分割功能提供了清晰的皮质表面3DR。我们使用BET显示脑回、脑沟和病灶周围血管，以获得进一步的解剖标志，以指导手术入路。皮质表面与重建的皮质3D图像的视觉匹配允许快速定位皮质和皮质下病变。主要的限制是病变的深度超过3厘米。结论大脑皮质标志物的形状识别不受脑变形的影响，因为脑沟和皮质血管之间几乎总是有一种没有因脑水肿或脑脊液渗漏而改变的关系。这种3DR使我们能够以一种简单、便携和廉价的方式重建虚拟解剖结构。在某些情况下，这项技术是使用昂贵的神经导航工具的一种有效和安全的替代方法，在发展中国家有潜在的帮助。
Background We describe a simple, safe, and inexpensive technique that through the comparison of three-dimensional (3D)-rendered magnetic resonance (MR) images and real anatomy allows us to navigate and remove brain lesions, including those without cortical appearance, by direct recognition of anatomical landmarks. Preoperative planning no longer requires the use of fiducials and can therefore be performed out a stereotactic setting.Methods MR Digital Imaging and Communications in Medicine format scans of 93 patients were reconstructed using MRIcro freeware for their three-dimensional rendering (3DR). The main location of the lesions was rolandic or left temporal, and most of them were without cortical appearance (78%). The two-dimensional (2D) sets of images were processed by the software to perform a 3DR, thus obtaining a virtual model of the patient's head. Using the same 2D sets, the edges of the lesion's images were contoured by the region of interest (ROI) tool. In the next step, the ROI was projected onto the surface of the virtual model of the patient's head, thus helping to attain the best identification of the craniotomy area. MRIcro automatic segmentation function, the Brain Extraction Tool (BET), provides a clear 3DR of the cortical surface. We used BET to display gyri, sulci, and perilesional vessels to have further anatomical landmarks to guide the surgical approach.Results The lesions were accessed through an optimally suited craniotomy. The visual matching of the cortical surface with reconstructed 3D images of the cortex permitted a fast localization of cortical and subcortical lesions. The major limitation is the depth of a lesion deeper than 3 cm. In these cases, the use of frame-based or frameless techniques still seems safer and more advantageous.Conclusions The shape recognition of the cortical landmarks was not biased by brain distortion because the sulci and cortical vessels almost always had a relationship to each other that was not modified by edema or cerebrospinal fluid leakage. This 3DR allows us to reconstruct a virtual anatomy in an easy, portable, and inexpensive way. In selected cases, this technique represents a valid and safe alternative to the use of costly neuronavigation tools and is potentially helpful in developing countries.