Virtual Reality Planning of Microvascular Decompression in Trigeminal Neuralgia: Technique and Clinical Outcome.

Background:  A neurovascular conflict (NVC) is considered the cause of trigeminal neuralgia (TN) in 75% of cases, and if so, a microvascular decompression (MVD) can lead to significant pain relief. A reliable preoperative detection of NVC is essential for clinical decision-making and surgical planning, making detailed neuroradiologic imaging an important component. We present our experiences and clinical outcomes with preoperative planning of the MVD procedure in a virtual reality (VR) environment, based on magnetic resonance imaging (MRI) including magnetic resonance angiography (MRA) and magnetic resonance venography (MRV) sequences.

Operative Anatomy of the Skull Base: 3D Exploration with a Highly Detailed Interactive Atlas.

 We evaluated the usefulness of a three-dimensional (3D) interactive atlas to illustrate and teach surgical skull base anatomy in a clinical setting.  A highly detailed atlas of the adult human skull base was created from multiple high-resolution magnetic resonance imaging (MRI) and computed tomography (CT) scans of a healthy Caucasian male. It includes the parcellated and labeled bony skull base, intra- and extracranial vasculature, cranial nerves, cerebrum, cerebellum, and brainstem.

sEVD-smartphone-navigated placement of external ventricular drains.

Background: Currently, the trajectory for insertion of an external ventricular drain (EVD) is mainly determined using anatomical landmarks. However, non-assisted implantations frequently require multiple attempts and are associated with EVD malpositioning and complications. The authors evaluated the feasibility and accuracy of a novel smartphone-guided, angle-adjusted technique for assisted implantations of an EVD (sEVD) in both a human artificial head model and a cadaveric head.

Aneurysm Surgery with Preoperative Three-Dimensional Planning in a Virtual Reality Environment: Technique and Outcome Analysis.

Objective: Aneurysm surgery demands precise spatial understanding of the vascular anatomy and its surroundings. We report on a decade of experience planning clipping procedures preoperatively in a virtual reality (VR) workstation and present outcomes with respect to mortality, morbidity, and aneurysm occlusion rate.

Methods: Between 2006 and 2015, the clipping of 115 intracranial aneurysms in 105 patients was preoperatively planned with the Dextroscope, a stereoscopic, patient-specific VR environment.

Endoscopic fenestration of intraventricular cerebrospinal fluid cysts: the contralateral approach.

Objective: The endoscopic fenestration of intraventricular CSF cysts has evolved into a well-accepted treatment modality. However, definition of the optimal trajectory for endoscopic fenestration may be difficult. Distorted ventricular anatomy and poor visibility within the cyst due to its contents can make endoscopic fenestration challenging if approached from the ipsilateral side.

Combining 5-Aminolevulinic Acid Fluorescence and Intraoperative Magnetic Resonance Imaging in Glioblastoma Surgery: A Histology-Based Evaluation.

Background: Glioblastoma resection guided by 5-aminolevulinic acid (5-ALA) fluorescence and intraoperative magnetic resonance imaging (iMRI) may improve surgical results and prolong survival.

Objective: To evaluate 5-ALA fluorescence combined with subsequent low-field iMRI for resection control in glioblastoma surgery.

Methods: Fourteen patients with suspected glioblastoma suitable for complete resection of contrast-enhancing portions were enrolled.

Stereoscopic neuroanatomy lectures using a three-dimensional virtual reality environment.

Introduction: Three-dimensional (3D) computer graphics are increasingly used to supplement the teaching of anatomy. While most systems consist of a program which produces 3D renderings on a workstation with a standard screen, the Dextrobeam virtual reality VR environment allows the presentation of spatial neuroanatomical models to larger groups of students through a stereoscopic projection system.

Materials And Methods: Second-year medical students (n=169) were randomly allocated to receive a standardised pre-recorded audio lecture detailing the anatomy of the third ventricle accompanied by either a two-dimensional (2D) PowerPoint presentation (n=80) or a 3D animated tour of the third ventricle with the DextroBeam.

The supraorbital keyhole approach: how I do it.

Background: Improvements in image guidance, endoscopy, and instruments, have significantly advanced "keyhole" neurosurgery. We describe the concept and technique of the supraorbital keyhole approach.

Methods: The supraorbital keyhole approach is performed through an eyebrow skin incision.

Patients' cosmetic satisfaction, pain, and functional outcomes after supraorbital craniotomy through an eyebrow incision.

Object: The supraorbital approach through an eyebrow incision offers the opportunity to access a wide variety of lesions of the anterior, middle, and even the posterior fossa. The minimally invasive keyhole craniotomy limits brain exploration and retraction and offers the potential for improved surgical outcomes and reduced approach-related complications. Patient satisfaction, however, has not yet been reported in the literature.

Brainstem cavernoma surgery with the support of pre- and postoperative diffusion tensor imaging: initial experiences and clinical course of 23 patients.

The spatial complexity of highly vulnerable structures makes surgical resection of brainstem cavernomas (BSC) a challenging procedure. Diffusion tensor imaging (DTI) allows for the visualization of white matter tracts and enables a better understanding of the anatomical location of corticospinal and sensory tracts before and after surgery.We investigated the feasibility and clinical usefulness of DTI-based fiber tractography in patients with BSC.

Image-guided neurosurgery with 3-dimensional multimodal imaging data on a stereoscopic monitor.

Background: In the past 2 decades, intraoperative navigation technology has changed preoperative and intraoperative strategies and methodology tremendously.

Objective: To report our first experiences with a stereoscopic navigation system based on multimodality-derived, patient-specific 3-dimensional (3-D) information displayed on a stereoscopic monitor and controlled by a virtual user interface.

Methods: For the planning of each case, a 3-D multimodality model was created on the Dextroscope.

Mono-stereo-autostereo: the evolution of 3-dimensional neurosurgical planning.

Background: In the past decade, surgery planning has changed significantly. The main reason is the improvements in computer graphical rendering power and display technology, which turned the plain graphics of the mid-1990s into interactive stereoscopic objects.

Objective: To report our experiences with 2 virtual reality systems used for planning neurosurgical operations.

The keyhole concept in neurosurgery.

Objective: Improvements in preoperative diagnostic imaging as well as in microsurgical techniques significantly advanced the development of transcranial neurosurgery, allowing the treatment of complicated diseases through smaller and more specific approaches.

Methods: In this article, authors overviewed their experience in transcranial endoscope-assisted microsurgery, using limited-sized keyhole craniotomies. Over a 10-year period, authors treated more than 3000 patients according to the transcranial endoscope-assisted microsurgery concept, advanced by the pioneer of minimally invasive neurosurgery, Axel Perneczky.

Rare suprasellar glioblastoma: report of two cases and review of the literature.

Background And Importance: The suprasellar and hypothalamic/chiasmatic regions can harbor a broad range of pathologic conditions, both neoplastic and nonneoplastic; however, malignant gliomas are extremely rare in those regions.

Clinical Presentations: Patient 1 was a 70 year-old man with weight loss and rapidly progressive visual impairment. A mass centered in the hypothalamus was detected on magnetic resonance (MR) imaging.

Subdural drainage versus subperiosteal drainage in burr-hole trepanation for symptomatic chronic subdural hematomas.

Background: Symptomatic chronic subdural hematoma (scSDH) is one of the most frequent diseases in neurosurgical practice, and its incidence is increasing. However, treatment modalities are still controversial.

Object: The aim of this retrospective single-center study is to compare for the first time two surgical methods in the treatment of subdural hematoma that have been proven to be efficient in previous studies in a direct comparison.

Small supratentorial, extraaxial primitive neuroectodermal tumor causing large intracerebral hematoma.

A 16-year-old boy presented with an unusual case of a supratentorial, extraaxial small round blue cell tumor of the central nervous system, which was most likely a primitive neuroectodermal tumor (PNET). Preoperative computed tomography and magnetic resonance imaging showed a large multistage hematoma in the left central region. Intraoperatively, a small, superficial tumorous lesion was found between the sagittal sinus and a large cortical vein hidden by the hematoma.

Advantages and limitations of intraoperative 3D ultrasound in neurosurgery. Technical note.

Three-dimensional ultrasound (US) technology is supposed to help combat some of the orientation difficulties inherent to two-dimensional US. Contemporary navigation solutions combine reconstructed 3D US images with common navigation images and support orientation. New real-time 3D US (without neuronavigation) is more time effective, but whether it further assists in orientation remains to be determined.

Neurosurgical craniotomy localization using a virtual reality planning system versus intraoperative image-guided navigation.

Purpose: Accurate craniotomy placement is essential for frameless neuronavigation in minimally invasive neurosurgery. A craniotomy using virtual reality (VR) can be as accurate as neuronavigation.

Methods: We prospectively enrolled 48 patients that underwent minimally invasive cranial procedures planned using VR, followed by neuronavigation.

Dex-ray: augmented reality neurosurgical navigation with a handheld video probe.

Objective: We developed an augmented reality system that enables intraoperative image guidance by using 3-dimensional (3D) graphics overlaid on a video stream. We call this system DEX-Ray and report on its development and the initial intraoperative experience in 12 cases.

Methods: DEX-Ray consists of a tracked handheld probe that integrates a lipstick-size video camera.

Virtual temporal bone: an interactive 3-dimensional learning aid for cranial base surgery.

Objective: We have developed an interactive virtual model of the temporal bone for the training and teaching of cranial base surgery.

Methods: The virtual model was based on the tomographic data of the Visible Human Project. The male Visible Human's computed tomographic data were volumetrically reconstructed as virtual bone tissue, and the individual photographic slices provided the basis for segmentation of the middle and inner ear structures, cranial nerves, vessels, and brainstem.

Surgical planning for microsurgical excision of cerebral arterio-venous malformations using virtual reality technology.

Background: To evaluate the feasibility of surgical planning using a virtual reality platform workstation in the treatment of cerebral arterio-venous malformations (AVMs)

Methods: Patient-specific data of multiple imaging modalities were co-registered, fused and displayed as a 3D stereoscopic object on the Dextroscope, a virtual reality surgical planning platform. This system allows for manipulation of 3D data and for the user to evaluate and appreciate the angio-architecture of the nidus with regards to position and spatial relationships of critical feeders and draining veins. We evaluated the ability of the Dextroscope to influence surgical planning by providing a better understanding of the angio-architecture as well as its impact on the surgeon's pre- and intra-operative confidence and ability to tackle these lesions.

Surgical complications after endoscopic transsphenoidal pituitary surgery.

Between January 2004 and June 2007 we conducted a retrospective analysis to assess post-operative complications related to endoscopic pituitary surgery in a series of 150 patients. Patients were treated with an endoscopic endonasal transsphenoidal approach to the sellar region for removal of pathological sellar and suprasellar lesions. We analysed the complications in groups according to the anatomical structures of the approach and the functional systems of the pituitary gland (anterior and posterior endocrine systems), and compared them to a large historical series using the traditional microsurgical transsphenoidal approach.