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High Performance Computing in Image Guided Therapy: Computer Assisted Three-Dimensional Planning and Real-Time Navigation for Neurosurgical Procedures

We routinely use three-dimensional (3D) reconstruction MRI tec hniques to understand the anatomic complexity of operative brain lesions and improve preoperative surgical planning. Additionally, we incorporate fun ctional (f-MRI) and metabolic data (PET, SPECT) into the surgical planning, on a case to case basis, using a co-registration algorithm based on maximiz ation of the inherent mutual information contained in the different data sets (MMI) [44]. Surgical planning is performed using MRI based 3D renderings of surgically critical structures such as eloquent cortex, gray matter nuclei, white matter tracts and blood vessels. Simulations using interactive manipul ation of 3D data provide an efficient and comprehensive way to appreciate the anatomic relationships of the lesion with respect to the eloquent brain areas and vessels. They provide otherwise inaccessible information, essential for the safe and possibly complete surgical removal of brain lesions. In a second, still experimental step, we propose the use of the 3D reconstruction during surgery, in conjunction with our operative open configuration MR scanner (Signa SP) and real time navigation system, thus facilitating the real-time visualization and quantitative assessment of the intraoperative changes, with the final goal of further reducing the invasiveness, increasing the radicality and safety of the procedure and improving the patient’s outcome.