title: Presurgical simulation with advanced 3-dimensional multifusion volumetric imaging in patients with skull base tumors.
abstract: BACKGROUND
  Despite recent diagnostic and technical advancements in the field of neurosurgery, surgical treatment for tumors in the skull base region, ie, skull base tumors (SBTs), remains a challenge.
  
  
  OBJECTIVE
  To validate the utility of presurgical simulation for the treatment of SBTs by 3-dimensional multifusion volumetric imaging (3D MFVI), including volume rendering and image fusion, to combine data from various imaging modalities.
  
  
  METHODS
  We performed presurgical simulation using 3D MFVI for 21 SBTs (acoustic neurinomas, jugular neurinomas, meningiomas, chordomas, and others) in 20 patients. We collected targeted data from computed tomography, magnetic resonance imaging, computed tomography or magnetic resonance angiography, and digital subtraction angiography and combined these data using image-analyzing software. The simulations were used to assess the 3D relationships among the microsurgical anatomical components, the appropriate surgical approach, and the resectable parts of the tumor. Finally, we compared the results of the simulation with the operative results.
  
  
  RESULTS
  In all patients, the 3D MFVI techniques enabled adequate visualization of the microsurgical anatomy and facilitated presurgical simulation, thereby allowing the surgeons to determine an appropriate and feasible surgical approach. All procedures to open the bone window were performed in accordance with the simulations, except for the surgical exposure of the acoustic canal for 2 acoustic neurinomas. In 3 of the 21 cases, tumor removal could not be performed according to the simulations because of unexpected bleeding or other restrictions.
  
  
  CONCLUSIONS
  The 3D MFVI technique was of a sufficiently high quality to enable visualization of the 3D microsurgical anatomy. This promising method can facilitate determination of the most appropriate approach and safe and precise surgical procedures for SBTs.
authors.affiliation: Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan. mac.oishi@mac.com
authors.forename: Makoto
authors.initials: M
authors.lastname: Oishi
authors.forename: Masafumi
authors.initials: M
authors.lastname: Fukuda
authors.forename: Go
authors.initials: G
authors.lastname: Ishida
authors.forename: Akihiko
authors.initials: A
authors.lastname: Saito
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hiraishi
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Fujii
mesh_terms: D000328:Adult; D000368:Aged; D002675:Child, Preschool; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011300:Preoperative Care / Q000379:methods*; D019292:Skull Base Neoplasms / Q000175:diagnosis* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D055815:Young Adult