NIMG-43DUAL VOLUME VISUALIZATION (3D-DSA AND CROSS-SECTIONAL IMAGING) FOR SURGICAL PLANNING OF INTRACRANIAL MENINGIOMAS

Abstract

INTRODUCTION: Many techniques about planning for the surgery of intracranial brain tumors have been considered for getting more information about the relationship between tumors and adjacent vasculatures. Especially for the surgery of meningiomas, it is essential to distinguish passing arteries from feeders. It is also very important to preserve venous structures. Dual volume visualization is apt and powerful method to know about these vascular structures. METHOD(S): Between Feb. 2012 and Dec. 2014, a total of 20 patients underwent brain tumor surgery after undergoing dual volume visualization. The tumors comprised of 1 glioblastoma, 1 medulloblastoma, and 18 meningiomas. The locations of meningiomas were as follows : 6 parasagittal; 4 falx; 2 convexity; 1 tentorial; 1 foramen magnum; 2 sphenoid wing; 1 petroclival; and 1 olfactory groove. RESULT(S): In cases involving glioblastoma and medulloblastoma, the boundary between the distinctive tumor mass of the intrinsic tumor and the normal brain is unclear, resulting in post-operative assessments showing greater direct damage done to the normal brain than that caused by vessel injury. Vascular supply and disfiguring observed in preoperative dual volume visualization images closely resembled the actual observations made during the surgery of meningiomas. Three out of eighteen meningioma cases demonstrated new deficits. One case exhibited tumor bed bleeding and perilesional edema leading to aggravation of motor weakness and deterioration. One exhibited venous infarction and a separate delayed hemorrhage leading to motor weakness and deterioration. One developed facial palsy. CONCLUSION(S): The advantages of this technique are as follows: 1. It enables the visualization of arteries and veins, individually; 2. the 3D rotation allows for convenient presurgical orientation; 3. it permits simulating craniotomies. This technique could reduce the incidence of newly developed neurological deficits as a result of identifying which veins to preserve during surgery and predicting the arteries that may shift.