title: Brain tumor surgery with 3-dimensional surface navigation.
abstract: BACKGROUND
  Precise lesion localization is necessary for neurosurgical procedures not only during the operative approach, but also during the preoperative planning phase.
  
  
  OBJECTIVE
  To evaluate the advantages of 3-dimensional (3-D) brain surface visualization over conventional 2-dimensional (2-D) magnetic resonance images for surgical planning and intraoperative guidance in brain tumor surgery.
  
  
  METHODS
  Preoperative 3-D brain surface visualization was performed with neurosurgical planning software in 77 cases (58 gliomas, 7 cavernomas, 6 meningiomas, and 6 metastasis). Direct intraoperative navigation on the 3-D brain surface was additionally performed in the last 20 cases with a neurosurgical navigation system. For brain surface reconstruction, patient-specific anatomy was obtained from MR imaging and brain volume was extracted with skull stripping or watershed algorithms, respectively. Three-dimensional visualization was performed by direct volume rendering in both systems. To assess the value of 3-D brain surface visualization for topographic lesion localization, a multiple-choice test was developed. To assess accuracy and reliability of 3-D brain surface visualization for intraoperative orientation, we topographically correlated superficial vessels and gyral anatomy on 3-D brain models with intraoperative images.
  
  
  RESULTS
  The rate of correct lesion localization with 3-D was significantly higher (P = .001, χ), while being significantly less time consuming (P < .001, χ) compared with 2-D images. Intraoperatively, visual correlation was found between the 3-D images, superficial vessels, and gyral anatomy.
  
  
  CONCLUSIONS
  The proposed method of 3-D brain surface visualization is fast, clinically reliable for preoperative anatomic lesion localization and patient-specific planning, and, together with navigation, improves intraoperative orientation in brain tumor surgery and is relatively independent of brain shift.
authors: Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, Vienna, Austria.
authors: Ayguel
authors: A
authors: Mert
authors: Katja
authors: K
authors: Buehler
authors: Garnette R
authors: GR
authors: Sutherland
authors: Boguslaw
authors: B
authors: Tomanek
authors: Georg
authors: G
authors: Widhalm
authors: Gregor
authors: G
authors: Kasprian
authors: Engelbert
authors: E
authors: Knosp
authors: Stefan
authors: S
authors: Wolfsberger
mesh_terms: D000465:Algorithms; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D038361:Neuronavigation / Q000379:methods*; D012984:Software