• Ayguel Mert, Katja Buehler, Garnette R Sutherland, Boguslaw Tomanek, Georg Widhalm, Gregor Kasprian, Engelbert Knosp, and Stefan Wolfsberger.
• Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, Vienna, Austria.
• Neurosurgery. 2012 Dec 1;71(2 Suppl Operative):ons286-94; discussion ons294-5.

BackgroundPrecise lesion localization is necessary for neurosurgical procedures not only during the operative approach, but also during the preoperative planning phase.ObjectiveTo evaluate the advantages of 3-dimensional (3-D) brain surface visualization over conventional 2-dimensional (2-D) magnetic resonance images for surgical planning and intraoperative guidance in brain tumor surgery.MethodsPreoperative 3-D brain surface visualization was performed with neurosurgical planning software in 77 cases (58 gliomas, 7 cavernomas, 6 meningiomas, and 6 metastasis). Direct intraoperative navigation on the 3-D brain surface was additionally performed in the last 20 cases with a neurosurgical navigation system. For brain surface reconstruction, patient-specific anatomy was obtained from MR imaging and brain volume was extracted with skull stripping or watershed algorithms, respectively. Three-dimensional visualization was performed by direct volume rendering in both systems. To assess the value of 3-D brain surface visualization for topographic lesion localization, a multiple-choice test was developed. To assess accuracy and reliability of 3-D brain surface visualization for intraoperative orientation, we topographically correlated superficial vessels and gyral anatomy on 3-D brain models with intraoperative images.ResultsThe rate of correct lesion localization with 3-D was significantly higher (P = .001, χ), while being significantly less time consuming (P < .001, χ) compared with 2-D images. Intraoperatively, visual correlation was found between the 3-D images, superficial vessels, and gyral anatomy.ConclusionThe proposed method of 3-D brain surface visualization is fast, clinically reliable for preoperative anatomic lesion localization and patient-specific planning, and, together with navigation, improves intraoperative orientation in brain tumor surgery and is relatively independent of brain shift.

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