Three-Dimensional Virtual Intraoperative Reconstruction: A Novel Method to Explore a Virtual Neurosurgical Field.
- 作者列表："Nicolosi F","Spena G
BACKGROUND:Acquisition of neurosurgical anatomy knowledge requires the progressive construction of a 3-dimensional (3D) mental image from the study of 2-dimensional pictures. Tridimensional neuroimaging modeling and 3D pictures and videos have facilitated a better understanding of intricate brain anatomy. One of the main limitations of these methods however is that the user is unable to freely change his or her own point of view of the observed structures. The objective of this paper was to develop a 3D reconstruction method to facilitate learning and teaching of neurosurgery. METHODS:We developed a 3D reconstruction method by using 3D photogrammetry to convert intraoperative images into a fully explorable 3D textured model. We also developed a mobile application to navigate the virtual scenario by using the gyroscopic technology of mobile devices to simulate the different movements of the surgical microscope. We named this process 3D virtual intraoperative reconstruction (VIR). RESULTS:We report the detailed methodology for picture acquisition, 3D reconstruction, and visualization with some surgical examples since the first applications in 2015. We also demonstrate how these navigable models can be used to buildup hybrid images derived by the fusion of 3D intraoperative scenarios with neuroimaging-derived 3D models. CONCLUSIONS:3D VIR is a digital reconstruction method developed with the goal of facilitating the teaching and learning of neurosurgical anatomy by allowing the user to directly explore a surgical field and anatomic structures. The result is an interactive navigable 3D textured model for the analysis of the surgical approach and regional anatomy and for reconstruction of hybrid 3D scenarios.
背景: 神经外科解剖学知识的获取需要从二维图片的研究中逐步构建三维 (3D) 心理图像。三维神经成像建模和3D图片和视频有助于更好地理解复杂的大脑解剖结构。然而，这些方法的主要限制之一是用户不能自由地改变他或她自己对观察到的结构的观点。本文的目的是开发一种三维重建方法，以促进神经外科的学习和教学。 方法: 我们开发了一种三维重建方法，利用三维摄影测量将术中图像转换为可完全探索的三维纹理模型。我们还开发了一个移动应用程序，通过使用移动设备的陀螺仪技术来模拟手术显微镜的不同运动来导航虚拟场景。我们将这个过程命名为3D虚拟术中重建 (VIR)。 结果: 我们报告了自2015年首次应用以来的图像采集，3D重建和可视化的详细方法以及一些手术实例。我们还演示了如何使用这些可导航模型来构建通过3D术中场景与神经成像衍生的3D模型融合而获得的混合图像。 结论: 3D VIR是一种数字重建方法，旨在通过允许用户直接探索手术领域和解剖结构来促进神经外科解剖学的教学和学习。结果是交互式可导航3D纹理模型，用于分析手术入路和区域解剖结构以及重建混合3D场景。
METHODS:OBJECTIVES:The aim was to evaluate the image quality and sensitivity to artifacts of compressed sensing (CS) acceleration technique, applied to 3D or breath-hold sequences in different clinical applications from brain to knee. METHODS:CS with an acceleration from 30 to 60% and conventional MRI sequences were performed in 10 different applications in 107 patients, leading to 120 comparisons. Readers were blinded to the technique for quantitative (contrast-to-noise ratio or functional measurements for cardiac cine) and qualitative (image quality, artifacts, diagnostic findings, and preference) image analyses. RESULTS:No statistically significant difference in image quality or artifacts was found for each sequence except for the cardiac cine CS for one of both readers and for the wrist 3D proton density (PD)-weighted CS sequence which showed less motion artifacts due to the reduced acquisition time. The contrast-to-noise ratio was lower for the elbow CS sequence but not statistically different in all other applications. Diagnostic findings were similar between conventional and CS sequence for all the comparisons except for four cases where motion artifacts corrupted either the conventional or the CS sequence. CONCLUSIONS:The evaluated CS sequences are ready to be used in clinical daily practice except for the elbow application which requires a lower acceleration. The CS factor should be tuned for each organ and sequence to obtain good image quality. It leads to 30% to 60% acceleration in the applications evaluated in this study which has a significant impact on clinical workflow. KEY POINTS:• Clinical implementation of compressed sensing (CS) reduced scan times of at least 30% with only minor penalty in image quality and no change in diagnostic findings. • The CS acceleration factor has to be tuned separately for each organ and sequence to guarantee similar image quality than conventional acquisition. • At least 30% and up to 60% acceleration is feasible in specific sequences in clinical routine.
METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.
METHODS:OBJECTIVE:The primary purpose of this study was to evaluate the effectiveness of a three-dimensional (3D) software tool (smart planes) for displaying fetal brain planes, and the secondary purpose was to evaluate its accuracy in performing automatic measurements. MATERIAL AND METHODS:This prospective study included singleton fetuses with a gestational age (GA) greater than 18 weeks. Transabdominal two-dimensional ultrasound (2DUS) and 3D smart planes images were respectively used to obtain the basic planes of the fetal brain, with five parameters measured. The images, by either two-dimensional (2D) manual or 3D automatic operation, were reviewed by two experienced sonographers. The agreements between two measurements were analyzed. RESULTS:A total of 226 cases were included. The rates of successful detection by automatic display were as high as 80%. There was substantial agreement between the measurements of the biparietal diameter, head circumference and transcerebellar diameter, but poor agreement between the measurements of cisterna magna and lateral ventricle width. CONCLUSIONS:Smart Planes might be valuable for the rapid evaluation of fetal brain, because it simplifies the evaluation process. However, the technology requires improvement. In addition, this technology cannot replace the conventional manual US scans; it can only be used as an additional approach.