title: Interactive presurgical simulation applying advanced 3D imaging and modeling techniques for skull base and deep tumors.
abstract: OBJECTIVE
  In this paper, the authors' goal was to report their novel presurgical simulation method applying interactive virtual simulation (IVS) using 3D computer graphics (CG) data and microscopic observation of color-printed plaster models based on these CG data in surgery for skull base and deep tumors.
  
  
  METHODS
  For 25 operations in 23 patients with skull base or deep intracranial tumors (meningiomas, schwannomas, epidermoid tumors, chordomas, and others), the authors carried out presurgical simulation based on 3D CG data created by image analysis for radiological data. Interactive virtual simulation was performed by modifying the 3D CG data to imitate various surgical procedures, such as bone drilling, brain retraction, and tumor removal, with manipulation of a haptic device. The authors also produced color-printed plaster models of modified 3D CG data by a selective laser sintering method and observed them under the operative microscope.
  
  
  RESULTS
  In all patients, IVS provided detailed and realistic surgical perspectives of sufficient quality, thereby allowing surgeons to determine an appropriate and feasible surgical approach. Surgeons agreed that in 44% of the 25 operations IVS showed high utility (as indicated by a rating of "prominent") in comprehending 3D microsurgical anatomies for which reconstruction using only 2D images was complicated. Microscopic observation of color-printed plaster models in 12 patients provided further utility in confirming realistic surgical anatomies.
  
  
  CONCLUSIONS
  The authors' presurgical simulation method applying advanced 3D imaging and modeling techniques provided a realistic environment for practicing microsurgical procedures virtually and enabled the authors to ascertain complex microsurgical anatomy, to determine the optimal surgical strategies, and also to efficiently educate neurosurgical trainees, especially during surgery for skull base and deep tumors.
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: Naoki
authors.initials: N
authors.lastname: Yajima
authors.forename: Kenzo
authors.initials: K
authors.lastname: Yoshida
authors.forename: Machiko
authors.initials: M
authors.lastname: Takahashi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hiraishi
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Takao
authors.forename: Akihiko
authors.initials: A
authors.lastname: Saito
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Fujii
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002817:Chordoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003198:Computer Simulation; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D008953:Models, Anatomic; D009442:Neurilemmoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012984:Software; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface; D055815:Young Adult