High-quality multimodal volume rendering for preoperative planning of neurosurgical interventions

Surgical approaches tailored to an individual patient's anatomy and pathology have become standard in neurosurgery. Precise preoperative planning of these procedures, however, is necessary to achieve an optimal therapeutic effect. Therefore, multiple radiological imaging modalities are used prior to surgery to delineate the patient's anatomy, neurological function, and metabolic processes. Developing a three-dimensional perception of the surgical approach, however, is traditionally still done by mentally fusing multiple modalities. Concurrent 3D visualization of these datasets can, therefore, improve the planning process significantly. In this paper we introduce an application for planning of individual neurosurgical approaches with high-quality interactive multimodal volume rendering. The application consists of three main modules which allow to (1) plan the optimal skin incision and opening of the skull tailored to the underlying pathology; (2) visualize superficial brain anatomy, function and metabolism; and (3) plan the patient-specific approach for surgery of deep-seated lesions. The visualization is based on direct multi-volume raycasting on graphics hardware, where multiple volumes from different modalities can be displayed concurrently at interactive frame rates. Graphics memory limitations are avoided by performing raycasting on bricked volumes. For preprocessing tasks such as registration or segmentation, the visualization modules are integrated into a larger framework, thus supporting the entire workflow of preoperative planning.