Image-Guided Neurosurgery With 3-Dimensional Multimodal Imaging Data on a Stereoscopic Monitor

Abstract

In the past 2 decades, intraoperative navigation technology has changed preoperative and intraoperative strategies and methodology tremendously. To report our first experiences with a stereoscopic navigation system based on multimodality-derived, patient-specific 3-dimensional (3-D) information displayed on a stereoscopic monitor and controlled by a virtual user interface. For the planning of each case, a 3-D multimodality model was created on the Dextroscope. The 3-D model was transferred to a console in the operating room that was running Dextroscope-compatible software and included a stereoscopic LCD (liquid crystal display) monitor (DexVue). Surgery was carried out with a standard frameless navigation system (VectorVision, BrainLAB) that was linked to DexVue. Making use of the navigational space coordinates provided by the VectorVision system during surgery, we coregistered the patient's 3-D model with the actual patient in the operating room. The 3-D model could then be displayed as seen along the axis of a handheld probe or the microscope view. The DexVue data were viewed with polarizing glasses and operated via a 3-D interface controlled by a cordless mouse containing inertial sensors. The navigational value of DexVue was evaluated postoperatively with a questionnaire. A total of 39 evaluations of 21 procedures were available. In all 21 cases, the connection of VectorVision with DexVue worked reliably, and consistent spatial concordance of the navigational information was displayed on both systems. The questionnaires showed that in all cases the stereoscopic 3-D data were preferred for navigation. In 38 of 39 evaluations, the spatial orientation provided by the DexVue system was regarded as an improvement. In no case was there worsened spatial orientation. We consider navigating primarily with stereoscopic, 3-D multimodality data an improvement over navigating with image planes, and we believe that this technology enables a more intuitive intraoperative interpretation of the displayed navigational information and hence an easier surgical implementation of the preoperative plan.