Author/Editor		Žele, Tilen; Matos, Boštjan; Prestor, Borut; Knific, Jernej; Bajrović, Fajko F
Title		Računalniško podprto predoperativno interaktivno 3-D načrtovanje operativnega posega v nevrokirurgiji
Translated title		Computer assisted pre-oeprative interactive 3-D planning of surgical procedures in neurosurgery
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 75, št. 11
Publication year		2006
Volume		str. 703-11
Language		slo
Abstract		Present paper describes our experiences with the use of three-dimensional (3D) reconstruction of medical images forpre-operative planning and intra-operative navigation in neurosurgery of cortical and sub-cortical tumors. In Z 0 patients with cortical and sub-cortical tumors, before surgery 3D models of tumor, normal nearby brain tissue and cortical veins were reconstructed from magnetic resonance images and in selected cases,functional magnetic resonance images using the computer program »3D Slicer«. Based on these models, the skin incision, trepanation opening and trans-cortical approach to the tumor were planned in virtual3D computer space. Collected positional data were transferred from the 3D computer space to the operation,field using distances from the artificial and typical anatomical landmarks on skin and cortical surface. Computer assisted 3D reconstruction provided a surgeon with more accurate localization of tumor than conventional mental reconstruction of the 2D medical images. In all cases theposition, sizeandshape ofskin incision, trepanation opening, cortical veins, sulci and gyri visualized on computer screen before surgery matched the actual anatomy observed during surgical procedure. In all patients the lesion was precisely, found and macroscopically totally resected with minimal injury to the adjacent normal structures. Pre-operative computer assisted 3D reconstruction provides important additional information about spatial localization of cortical and sub-cortical tumors in comparison to mental reconstruction of 2D medical images. Therefore, it improves the accuracy ofplanning the surgical procedure and makes it less invasive and less risky.
Summary		Prispevek opisuje naše izkušnje z uporabo računalniško podprte predoperativne tridimenzionalne (3D) rekonstrukcije medicinskih slik za načrtovanje in medoperativno vodenje operativnega posega v nevrokirurgiji intrakranialnih tumorjev. Pred operativnim posegom smo iz slik magnetne resonance in v izbranih primerih, funkcionalne magnetne resonance s pomočjo računalniškega programa »3D Slicer« rekonstruirali 3D modele tumorja, okolne normalne možganovine in kortikalnih ven pri 70 bolnikih s kortikalnimi oz. subkortikalnimi tumorji. Na podlagi teh modelov smo v 3D računalniškem okolju načrtovali kožni rez, trepanacijsko odprtino in vstop skozi možganovino do tumorja. Slednje smo iz 3D modelov na operacijsko polje bolnika prenesli s pomočjo meritev razdalj do orientacijskih točk na površini skalpa oz. skorje možganov. Računalnisko podprta 3D rekonstrukcija je v primerjavi z običajno miselno rekonstrukcijo 2D medicinskih slik kirurgu omogočila bolj natančno prostorsko umestitev tumorja. Pri vseh bolnikih so se položaj, velikost in oblika kožnega reza in trepanacije ter položaj in odnos tumorja do kortikalnih ven in možganskih vijug v 3D računalniškem okolju pred operacijo ujemali z enakimi kvalitetami na operacijskem polju pri bolniku . Čeprav se,jepo iztekanju likvorja možganovina nekoliko premaknila, se relativna lokacija in odnos možganskih vijug, žilja in patoloških sprememb ni spremenil Pri vseh bolnikih smo z minimalno invazivnim posegom lahko natancno dosegli in makroskopsko odstranili tumor v celoti. Predoperativna računalnisko podprta 3D rekonstrukcija nudi kirurgu dodatno informacijo o prostorski umestitvi kortikalnih in subkortikalnih tumorjev v primerjavi z miselno rekonstrukcijo 2D medicinskih slik. Zato omogoca vecjo natancnost pri načrtovanju kirurškega pristopa in manjšo invazivnost ter tveganje operativnega posega.
Descriptors		BRAIN NEOPLASMS IMAGE PROCESSING, COMPUTER-ASSISTED MAGNETIC RESONANCE IMAGING TOMOGRAPHY, X-RAY COMPUTED