Neurosurgical simulation and neuronavigation with three-dimensional functional mapping

我们开发了一种术前模拟和术中导航系统，用于颅内手术的三维功能定位。该系统可以实现磁共振（MR）和计算机断层扫描（CT）图像的三维集成，从而产生头皮、大脑、颅骨、血管和病变的计算机图形复合。我们利用磁共振和CT图像的三维复合计算机图形（cg）研究了神经外科导航系统在颅内手术中的效果。我们使用三点变换对MR和CT图像进行整合。在患者头皮上放置三个皮肤标记物，获得MR和CT图像数据。这些数据经过体积渲染处理，生成头皮、大脑和mri病变的三维cg，以及头皮和颅骨的CT。通过对系统中MR和CT获得的三维渲染头皮图像上的三个标记进行配准，生成头皮、颅骨、脑和病变的复合cg。我们还改进了一种用于术中导航的三维数字化仪，该仪器使用了一个关节臂，其形状像刺刀，可互换探头，可通过狭窄的开口用于深部结构。该系统用于85例开颅手术患者，其中颅底病变患者14例。该系统用于立体定向开颅术，通过三维复合cg提供术前模拟和术中导航，提高了手术的安全性。在颅底外科手术中，使用我们的系统模拟复合cg的手术过程有助于理解颅底解剖并提供最佳方法。术中导航辅助确定颅底的实际空间位置和手术过程中肿瘤的最佳轨迹。

We developed a preoperative simulation and intraoperative navigation system for use with three-dimensional functional mapping in intracranial surgery. This system enables three-dimensional integration of magnetic resonance (MR) and computerized tomography (CT) images, and thereby yields computer graphic composites of the scalp, brain, skull, vessels, and lesions. We investigated the efficacy of a neurosurgical navigation system using three-dimensional composite computer graphics (CGs) of MR and CT images in intracranial surgery.We used three-point transformation for integration of MR and CT images. MR and CT image data were obtained with three skin markers placed on the patient's scalp. The data were subjected to volume-rendering manipulations to produce three-dimensional CGs of the scalp, brain and lesions from MR, and the scalp and skull from CT. Composite CGs of the scalp, skull, brain, and lesion were created by registering the three markers on the three-dimensional rendered scalp images obtained from MR and CT in the system. We also improved a three-dimensional digitizer for intraoperative navigation using an articulated arm with an interchangeable probe shaped like a bayonet, which can be used in deep structures through narrow openings.This system was used for 85 patients during open brain surgery, including 14 patients with skull base lesions. The use of this system for stereotactic craniotomy increased the safety of the surgery by affording preoperative simulation-and intraoperative navigation with the three-dimensional composite CGs. In skull base surgery, simulation of surgical procedures on composite CGs using our system aided comprehension of skull base anatomy and provided optimal approaches. Intraoperative navigation aided determination of actual spatial position in the skull base and the optimal trajectory to the tumor during surgical procedures.