2022 Volume 31 Issue 6 Pages 368-377
Brainstem cavernous malformation surgery is still challenging because preoperative prediction of deformed/transformed nuclei and conductive tracts inside the brainstem is still difficult. Visualizing the intraoperative neural function of these nuclei and tracts is also challenging.
To address these issues, we introduced both preoperative virtual surgical simulation using 3D computer graphics to predict the anatomical architecture and to perform intraoperative real-time continuous neurophysiological monitoring to visualize neural function.
In our surgical strategy, identification of brainstem nuclei and tracts in relation to cavernous malformation using virtual reality three-dimensional fusion images constructed from multimodality images is crucial in choosing the best surgical approach to minimize anatomical nuclei and tract injuries. Intraoperative neural function is visualized as a trend graph, and when it deteriorates, the relevant procedure should not be repeated further, and appropriate recuperation time should be allowed to prevent permanent damage.
Understanding the anatomical architecture of brainstem cavernous malformations and visualizing real-time neural function on a case-by-case basis is important for surgical strategizing. A representative case is presented here to summarize the key points of surgery.
