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

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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.