Use of preoperative 3D CT/MR fusion images and intraoperative CT to detect lesions that spread onto the brain surface.

OBJECTIVE: Preoperative 3D CT/MR fusion images were prepared for preoperative evaluations and intraoperative assistance for the following lesions: arteriovenous -malformations (AVMs), meningiomas, and metastatic tumors that spread onto the brain surface.

METHOD: We prepared 3D CT/MR fusion images for 4 AVMs, 13 meningiomas, and 7 metastatic tumors, and demonstrate representative cases. Data acquired from 16-slice multidetector CT and 1.5-T MRI were used. The volume rendering technique was used. During operations, mobile 16-slice multidetector CT was used to update information.

RESULTS: Even after opening the dura mater, the relationship between a brain surface lesion and the surrounding structures on the preoperative 3D fusion images corresponded to the patient's operation field. Updated information via intraoperative CT was useful because operation fields might change owing to the brain shift. These images made extirpations of lesions easier and less invasive.

CONCLUSION: Not only the preoperative 3D information, but also intraoperative CT information are beneficial for smooth and safe operations.