脳神経減圧術の3D術前シミュレーション

Preoperative 3D Microvascular Decompression Simulation

Point

・手術シミュレーションの三要素を意識することで，より適切な術前シミュレーションが可能となる．

・読影，co-registration，segmentation，手術シミュレーションのすべてのステップが重要である．

・組織変形のシミュレーションには未だ技術的な限界があるが，注意して利用すれば術前に術野を詳細に再現できる．

　Preoperative surgical simulation via three-dimensional fusion computer graphics models have been widely accepted as a legitimate means of securing the diagnosis and treatment effectiveness of neurovascular compression. The authors discussed three factors of surgical simulation as being 1. Knowing the anatomical relationship, 2. Knowing the desirable end result of surgical intervention, and 3. Knowing how to design surgical interventions to achieve such desirable end results. Satisfying each factor requires distinct functionality from the software used in the surgical simulation.

　As per the imaging study used to construct the multimodal computer graphic models, CT scan and MR are usually sufficient, although renal function-permitting contrast enhancement can be a feasible option for depicting minute vessels in particular.

　There are three major steps in building three-dimensional fusion computer graphics models:1. Image interpretation, 2. co-registration, and 3. Segmentation. Each step comprises an essential part that must be handled with care. The segmentation step is where rigorous technological advancement takes place, although classical techniques, such as the seeded region growing method or the multi-threshold method, are still practically important. Regarding surgical simulation after three-dimensional model construction, technical challenges concerning large deformations should be recognized to ensure non-nonsense surgical simulation.