Abstract
Modern neurosurgery uses preoperative imaging daily. Three-dimensional reconstruction of the cortical anatomy and of the superficial veins helps the surgeons plan and perform neurosurgical procedures much more safely. The target is always to give the patient maximum benefit in terms of outcome and minimize intraoperative and postoperative complications. This study aims to develop a method for the combined representation of the cerebral cortex anatomy and the superficial cerebral veins, whose integration is beneficial in daily practice. Only those patients who underwent surgical procedures with craniotomy and a large opening of the dura mater were included in this study, for a total of 23 patients, 13 females (56.5%) and 10 males (43.5%). The average age was 50.1 years. We used a magnetic resonance tomograph Magnetom Vision® 1.5T (Siemens AG). Two sequences were applied: a strongly T1-weighted magnetization-prepared rapid acquisition with gradient echo (MPRAGE) sequence to visualize cerebral anatomical structures, and a FLASH-2D-TOF angiography sequence to visualize the venous vessels on the cortical surface after the administration of a paramagnetic contrast agent. The two data sets were superimposed manually, co-registered in an interactive process, and merged to create a combined data set, segmented and visualized as a three-dimensional reconstruction. Furthermore, we present our method for visualizing superficial veins, which helps manage brain shift (BS). We also performed anatomical observations on the reconstructions. The reconstructions of the cortical and venous anatomy proved to be a valuable tool in surgical planning and positively influenced the surgical procedure. Due to the good correlation with the existing surgical site, this method should be validated on a larger cohort or in a multicentric study.
Highlights
This study aims to develop a method for the combined representation of the cerebral cortex anatomy and the superficial cerebral veins, whose integration is beneficial in daily practice
We examined the patients with two different sequences: magnetizationprepared rapid acquisition with gradient echo (MPRAGE) sequences, which are TurboFLASH sequences extended to 3D and allow high-contrast imaging of the brain, were acquired natively, and FLASH-2D-TOF angiography, to visualize the venous vessels in as high a contrast as possible (Perese, 1958; Stephens and Stilwell, 1969; Strother et al, 1994; Stevenson et al, 1995; Imai et al, 1996; Hunerbein et al, 1997; Liang et al, 2001; Immonen et al, 2004)
In six cases (3.4%), veins identified in the reconstructions could not be assessed in the surgical site (Category 4), as they were covered by cotton wool, already coagulated, or resected together with the surrounding tissue before we took the photograph
Summary
Threedimensional reconstruction of the cortical anatomy and of the superficial veins helps the surgeons plan and perform neurosurgical procedures and minimize complications. This study aims to develop a method for the combined representation of the cerebral cortex anatomy and the superficial cerebral veins, whose integration is beneficial in daily practice. We present our method for visualizing superficial veins, which helps manage brain shift (BS), as the veins on the cortical surface shift together with the underlying brain tissue and do not—or only minimally—change their relative location to the cortical landmarks. Our study includes x-rays, computer tomography, magnetic resonance tomography, and nuclear medicine examinations, as well as ultrasound images and photographs of the surgical site in the case of a previous surgical intervention. The reconstructions of the cortical and venous anatomy proved to be a valuable tool in surgical planning, and it influenced the surgical procedure positively
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