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

本项目旨在为神经外科患者的CT或MR图像开发简单的脑表面图像重建方法，使模拟手术和图像引导定位成为可能。这将大大提高神经外科手术的准确性和安全性。我们开发了一种简单实用的方法，在个人计算机的帮助下重建患者的脑表面解剖图像，以便更好地进行术前计划和手术定向。从t1加权磁共振（MR）图像的最浅层切片中选择代表皮质表面的区域。然后将选定的区域覆盖在下一个表面切片上，并调整对齐。通过重复这一过程四到七次，我们获得了清晰显示脑回和脑沟的脑表面图像。采用相同的方法，从t2加权图像或MR血管成像中获得脑表面血管成分图像。然后将脑表面和血管图像结合起来重建表面解剖图像（SAI）。此外，如有必要，还可以添加病变轮廓和自然地标，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显示计划手术入路方向的明显皮质表面的优势。单个患者获得的SAIs证明在日常神经外科手术的术前计划和最大限度地减少手术对皮层表面和皮层下病变的损伤时是有用的。

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.