Abstract
Whole brain tractography using diffusion tensor imaging (DTI) sequences can be used to map cerebral connectivity; however, this can be time-consuming due to the manual component of image manipulation required, calling for the need for a standardized, automated, and accurate fiber tracking protocol with automatic whole brain tractography (AWBT). Interpreting conventional two-dimensional (2D) images, such as computed tomography (CT) and magnetic resonance imaging (MRI), as an intraoperative three-dimensional (3D) environment is a difficult task with recognized inter-operator variability. Three-dimensional printing in neurosurgery has gained significant traction in the past decade, and as software, equipment, and practices become more refined, trainee education, surgical skills, research endeavors, innovation, patient education, and outcomes via valued care is projected to improve. We describe a novel multimodality 3D superposition (MMTS) technique, which fuses multiple imaging sequences alongside cerebral tractography into one patient-specific 3D printed model. Inferences on cost and improved outcomes fueled by encouraging patient engagement are explored.
Highlights
The use of x-rays (XR), computed tomography (CT), and magnetic resonance imaging (MRI) has been the standard for neurosurgical education, planning, and treatment
We have developed tools to aid us in the operating room but continue to lack a simple haptic representation of the anatomy of interest that can be used before a procedure
With conventional preoperative imaging modalities attempting to display spatial 3D structures viewed on a 2D screen, conceptualizing the 3D properties of the intracranial environment remains subject to error
Summary
The use of x-rays (XR), computed tomography (CT), and magnetic resonance imaging (MRI) has been the standard for neurosurgical education, planning, and treatment. T1 three-dimensional (3D) data is used as the anatomical base, and the data sets yielded from functional magnetic resonance imaging (fMRI) and tractography are assembled on and fused with the brain; tumor (green), fiber tracts (red), fMRI data (pink, yellow). Using magnetic resonance imaging (MRI) for anatomical base, we overlay three-dimensional (3D) objects representing the tumor (yellow), fiber tracts (blue), and functional magnetic resonance imaging (fMRI) data (red, pink, green) into one model in preparation for printing. With our institutional MMTS protocols and semi-automated tractography techniques, we have printed numerous patient-specific 3D models, two of which are showcased in this report (Figures 4-5) Using this all-inclusive model, which displays pertinent structures in relation to the lesion of interest, gives an overall view and full appreciation of critical functional areas and cerebral connectivity affected by the pathology.
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