A new simulation system utilizing digital images (CT/MRI/SPECT) and an ultrasound/laser navigation system has been developed for image-guided surgery. Preoperative CT/MRI imaging does not always indicate the actual location of the lesion during intracranial operation, because the lesion may be displaced or distorted by operative procedures or CSF flowout. The authors developed an image integration system including an intraopera- tive ultrasonogram, which provides accurate information not only on the location of the deep-seated lesions but also surrounding anatomical structures during operation. The rationale of the system is to coordinate the three-dimensional axes of each image with the aid of a stereotactic subframe. Our simulation system has two ways. One simulation system works on a SUN workstation. At the preoperative simulation study: the entry point on the brain surface and the access route to the lesion are decided on from the three-dimensional CT/MRI images on the computer display. Then the configuration of the lesion from the operative view is displayed as an expected ultrasound image by reconstructing the CT and/ or SPECT image. Another simulation system (HyperCAS) works on the HyperCard of a Macintosh. The target point, the entry point and the trajectory are decided on and the three- dimensional location of these points is measured from serial CT images on the LCD display. At the time of operation, stereotactic craniotomy is performed using the laser navigator. The extent of the lesion at every depth in the surgical process is predicted from these images, and the access route to the lesion is easily corrected with the intraoperative ultrasound navigator. Thus, the present system composes a refined supporting system for neurosurgical operation in terms of simulation and navigation in stereotactic neurosurgical operation.
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