title: Presurgical planning of feeder resection with realistic three-dimensional virtual operation field in patient with cerebellopontine angle meningioma.
abstract: BACKGROUND
  To devascularize meningiomas, the precise location of tumor attachment must be known. However, when a cerebellopontine angle (CPA) meningioma is in contact with many surrounding structures, it can be difficult to distinguish the most vascularized attachment (MVA) from other contact surfaces.
  
  
  OBJECTIVE
  To validate the usefulness of a virtual operation field (VOF) of a CPA meningioma by high-spatial-resolution three-dimensional computer graphics (hs-3DCG).
  
  
  METHODS
  Presurgical simulation with VOF was performed for eight CPA meningiomas to assess the MVA and the appropriate route to the main feeder. For hs-3DCG, the necessary preoperative radiographic images were fused. A hybrid model of volume and surface rendering was created from the fused images. The simulation results were compared with the operative results, and the MVA estimation rate was compared between VOF and contrast-enhanced fast imaging employing steady-state acquisition.
  
  
  RESULTS
  By using VOF, the point at which the main feeder penetrated the tumor was estimated in all cases, and using this information, the MVA was detected. All patients underwent resection of the main feeder in the same way as simulated preoperatively. Estimation rates of MVA were 37.5% in CE-FIESTA and 100% in VOF (p = 0.02, Fisher's exact test).
  
  
  CONCLUSIONS
  The hs-3DCG method was of sufficiently high quality to enable VOF of CPA meningioma. This method may facilitate estimation of MVA and the main feeder penetration point, and may aid in the determination of the most appropriate approach to the main feeder.
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. ymasa-tky@umin.ac.jp
authors.forename: Masanori
authors.initials: M
authors.lastname: Yoshino
authors.forename: Taichi
authors.initials: T
authors.lastname: Kin
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nakatomi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Oyama
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Saito
mesh_terms: D000328:Adult; D000368:Aged; D002528:Cerebellar Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002530:Cerebellopontine Angle / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008579:Meningioma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D011859:Radiography