Resident Physician University of Michigan Ann Arbor, Michigan, United States
Introduction: Thorough preoperative planning is essential in neurosurgery to ensure that operations occur in a choreographed and efficient manner. Variables to be considerate of include positioning, approach, incision, size and location of bony access to the intracranial and intraspinal compartments. Currently, majority of planning occurs based on cross-sectional imaging, such as CT or MRI, that the surgeon must consolidate and abstract for a 3D understanding. Though some virtual reality software exists, this comes with a hefty price tag and many restrictions.
Methods: Our group created a 3D modeling technique that synthesizes multimodality images (CT, MRI and digital subtraction angiography) for operative planning. Images are registered with 3D Slicer and segmented with Vitrea and 3D Slicer. The data is then imported into Blender, a free and open-source 3D software toolset, to create a complete virtual 3D model that includes relevant anatomy such as bone, artery, vein, tumor, etc. These models can be visualized on a web-based 3D viewing platform that is accessible to all mobile platforms without requiring installation of bulky software.
Results: To date, we have utilized this 3D modeling technique in numerous cases. Here, we present two cases: a large olfactory groove meningioma and a lumbar dural arteriovenous fistula. The 3D models of these patient’s pathologies show optimal positioning and bony removal for adequate access to the surgical lesion. Furthermore, we are able to show that the 3D models correlate to intraoperative anatomy based on surgical videos.
Conclusion : Overall, these models give us a more complete understanding of the relative surgical anatomy and are excellent tools for preoperative planning. Access to these models has also been instrumental in resident/student education. In the future, we plan to export these models into a virtual reality format to give surgeons the opportunity to interact with the models in as realistic a setting as possible.
