Simultaneous virtual representation of both vascular and neural tissue within the subarachnoid space of the basal...

The representation of different anatomical structures requires varying imaging modalities and protocols. By mental composition of single-slice images, a three-dimensional (3D) impression can be achieved. However, this presupposes an outstanding imagination and is subject to inaccuracies. The use of an interactive and multi-modal planning system which represents different data sets in one single virtual environment holds promise to facilitate and improve neurosurgical decision-making. The authors report the clinical application of a self-developed virtual planning system in a case of trigeminal neuralgia due to an ectatic basilar artery.

We modified our virtual planning system (VIVENDI), to achieve a virtual representation of the basal cistern illustrating both vascular and neuronal information. After conducting several experiments to determine an appropriate scanning protocol, we matched the data achieved by magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA).

The system provides the vascular topography combined with information on the anatomical structure of the subarachnoid space. To illustrate the clinical usefulness of this planning approach, the authors present a case of trigeminal neuralgia caused by an ectatic basilar artery. Pre-operatively, the virtual representation returned accurate information on the anatomical configuration of the cerebellopontine angle and the course of the ectatic vessel. This information was confirmed during surgery.

The presented case demonstrates the clinical applicability of VIVENDI within the subarachnoid space of the basal cistern. The virtual representation enables pre-operative planning and simulation based on the patient's individual anatomy.