Development of computer assisted neurosurgical techniques with reconstructed cerebral surface anatomical images for presurgical planning and image guided localization

该项目的目的是开发简单的重建方法，从CT或MR图像的神经外科患者的大脑表面图像，并使其能够进行模拟手术和图像引导定位。本文介绍了一种简单实用的脑表面解剖图像重建方法，可在微机上进行脑表面解剖图像的重建，以便于术前规划和手术定位。从T1加权磁共振（MR）图像的最浅表切片中选择代表皮质表面的区域。然后将选定区域覆盖在下一个浅表切片上，并调整对齐。重复4~7次，我们得到了脑表面图像，清晰地显示了脑回和脑沟。用同样的方法，从T2加权像或MR血管造影中获得脑表面血管成分的图像。然后将脑表面和血管图像组合以重建表面解剖图像（SAI）。此外，如有必要，还可添加病变轮廓和自然标志（如心室）。与传统的表面解剖扫描（SAS）或三维图像重建程序相比，我们的方法具有在合理的时间内从计划的手术方法的方向显示明显的皮质表面的优势。从个体患者中获得的SAI被证明在日常神经外科手术中对于术前规划和在接近表面和皮质下病变时最大限度地减少对功能皮质的手术损伤是有用的。

The aim of the project is to develop simple reconstruction method for cerebral surface images of the neurosurgical patient from CT or MR images and to make it possible to perform simulation surgery and image guided localization. This will enhance neurosurgical accuracy and safeness greatly.We have developed a simple and practical method to reconstruct cerebral surface anatomical images of patient for better presurgical planning and surgical orientation with an aid of a personal computer. The area representing the cortical surface was selected from the most superficial slice of the T1-weighted magnetic resonance (MR) image. The selected area was then overlaid upon the next superficial slice and the alignment adjusted. By repeating this procedure four to seven times, we obtained a brain surface image, which clearly displayd gyri and sulci. With the same method, image of the vascular components of the cerebral surface was obtained from the T2-weighted images or MR angiograms. The brain surface and the vascular images were then combined to reconstruct a surface anatomical image (SAI). In addition, the outline of the lesion and natural landmarks, such as ventricles, were added if necessary. Compared to conventional surface anatomy scanning (SAS) or three-dimensional image reconstruction procedures, our method has the advantage of displaying, within a reasonable time, the manifest cortical surface from the direction of the planned surgical approach. The SAIs obtained for individual patients proved to be useful in daily neurosurgical operations for presurgical planning and minimizing surgical damage to the eloquent cortex in approaching both surface and subcortical lesions.