ENHANCEMENT OF PREOPERATIVE NEUROSURGICAL PLANNING, USING 3D SEGMENTATION MODELS

Abstract

Objectives. The vertiginous, progressive development of the contemporary imaging techniques, such as computed tomography and magnetic resonance imaging, apparently led to an increase in the information volume, provided about anatomical structures and investigated pathological processes, but also, deficiencies in rendering information from the imager to the clinician didn’t improve and this is largely due to the fact that the information is still provided by 2D images. To utterly understand how things really are and to plan the surgery correctly, the surgeon relies on imagination, which largely depends on his own experience. To overcome these limitations, 3D technology can provide detailed information about the 3D orientation of normal anatomical structures, in relation to pathological ones. Our aim was to show the importance of 3D volume segmentation as a teaching and preoperative tool for neurosurgical interventions and to demonstrate our experience in clinical practice. Material and Methods. We chose Inobitec DICOM software. Multiple objects were fused to form a final 3D scene of the patient-specific anatomy. The models were exported for subsequent editing in external programs such as Meshmixer and Blender and then on portable devices for viewing. Results. We report a detailed methodology for picture acquisition, 3D reconstruction, and visualization with some surgical examples (clinical cases), treated in ”Diomid Gherman” Institute of Neurology and Neurosurgery, Chișinau, Republic of Moldova. We, also, demonstrate how these navigable models can be used to build up composite images, derived by the fusion of 3D intraoperative images with neuroimaging-derived 3D models. Conclusion. Our experience, in neurosurgery, has shown that this is an affordable technology with great opportunities. The models can be used for a variety of purposes (teaching, planning, 3D printing, and Virtual Reality). The creation of 3D models for planning is already used in several areas of neurosurgery.