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Presurgical Planning with Open-Source Horos Software for Superficial Brain Arteriovenous Malformations
Mauricio Mandel1, Yiping Li2, Eberval Gadelha Figueiredo3
1Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine and Stanford Health Care, Stanford, California, USA; Department of Neurosurgery, Hospital das Clinicas of University of São Paulo Medical School, São Paulo, Brazil.
This study shows 3D reconstruction software aids surgical planning for brain arteriovenous malformations (bAVMs). The software is most effective for frontal and parietal lobe bAVMs, improving visualization of angioarchitecture.
Area of Science:
- Neurosurgery
- Medical Imaging
- Computational Anatomy
Background:
- Surgical planning for brain arteriovenous malformations (bAVMs) is complex due to the intricate 3D angioarchitecture.
- Mentally visualizing bAVM anatomy is a skill that requires significant surgical experience.
- 3D reconstruction software may assist surgeons in understanding complex bAVM vasculature, potentially reducing the learning curve.
Purpose of the Study:
- To evaluate the clinical utility of free, online 3D reconstruction software for presurgical planning of bAVMs.
- To assess the software's accuracy in visualizing bAVM angioarchitecture by comparing 3D reconstructions with intraoperative findings.
Main Methods:
- Preoperative MRI/MRA images from 56 superficial bAVMs were processed using the open-source Horos software.
- 3D rendered images were created and compared with intraoperative views and recordings.
- The software's accuracy and value as a preoperative planning tool were evaluated.
Main Results:
- Useful visualizations of feeding arteries and draining veins were achieved in 62.5% (35/56) of cases.
- Reconstructions were less effective for small AVMs (nidus ≤2 cm) and those in the temporal or cerebellar cortex due to artifacts.
- Frontal and parietal lobe lesions showed significantly higher success rates in identifying key vascular structures (P < 0.05).
Conclusions:
- Horos software provides a comprehensive 3D analysis of bAVM angioarchitecture for presurgical planning.
- The technique is particularly beneficial for frontal and parietal lobe lesions, aiding surgical strategy development.
- 3D surface reconstructions offer a brain shift-independent surgical map.
