COMPUTER-ASSISTED SURGICAL PLANNING FOR CEREBROVASCULAR NEUROSURGERY

OBJECTIVE: We used three-dimensional reconstructed magnetic resonance images for planning the operations of 16 patients with various cerebro vascular diseases. We studied the cases of these patients to determine the advantages and current limitations of our computer-assisted surgi cal planning system as it applies to the treatment of vascular lesions . METHODS: Magnetic resonance angiograms or thin slice gradient echo m agnetic resonance images were processed for three-dimensional reconstr uction. The segmentation, based on the signal intensities and voxel co nnectivity, separated each anatomic structure of interest, such as the brain, vessels, and skin. A three-dimensional model was then reconstr ucted by surface rendering. This three-dimensional model could be colo red, made translucent, and interactively rotated by a mouse-controlled cursor on a workstation display. In addition, a three-dimensional blo od flow analysis was performed, if necessary. The three-dimensional mo del was used to assist in three stages of surgical planning, as follow s: 1) to choose the best method of intervention, 2) to evaluate surgic al risk, 3) to select a surgical approach, and 4) to localize lesions. RESULTS: The generation of three-dimensional models allows visualizat ion of pathological anatomy and its relationship to adjacent normal st ructures, accurate lesion volume determination, and preoperative compu ter-assisted visualization of alternative surgical approaches. CONCLUS ION: Computer-assisted surgical planning is useful for patients with c erebrovascular disease at various stages of treatment. Lesion identifi cation, therapeutic and surgical option planning, and intraoperative l ocalization are all enhanced with these techniques.