Application of virtual reality technology in the operation of brain tumors in central cortex and adjacent areas

Objective To address the value of multimodal image-based virtual reality technology in preoperative evaluation of resection of brain tumor in central cortex and adjacent areas. Methods A retrospective study was conducted on the clinical data of 36 patients with brain tumor in central cortex and adjacent areas who were admitted to Neurosurgery Department of the First Affiliated Hospital of Soochow University from December 2015 to April 2018. All patients underwent preoperative 3.0T MRI scan. Multimodal MRI images were then co-registered with the software iPlan followed by three-dimensional image reconstruction to generate virtual reality images. Evaluation of the relationship between tumor, brain vessels and eloquent areas was then performed according to the virtual reality model and compared with intra-operative findings. The brain tumors were resected under craniotomy microscope. Medical imaging examination and follow-up were performed after operation. Results For prediction of the relationship between tumor, eloquent area and vessels, multimodal image-based virtual reality showed the sensitivity of 94.4% (34/36). Among all 36 patients, total resection of glioma was achieved in 16 cases and subtotal resection in 2; total resection of meningioma was performed in 9 cases and subtotal resection in 1; total resection was achieved in 5 cases of cavernous hemangioma, 2 cases of metastatic tumor and 1 case of lymphoma. After surgery, 3 patients developed different degrees of limb motor impairment, of which 2 returned to normal after 3 months. One case developed transient speech disorders after surgery and returned to normal after 1 week. All patients were followed up for 20.2±5.4 months (10-38 months), and there were 3 patients showing recurrence in imaging examination. Conclusion The use of virtual reality technology is helpful to make an accurate assessment of the relationship between tumor and eloquent area as well as blood vessels near the tumor before surgery, and can help to improve the preoperative plan and improve the rate of total removal of tumor, thereby reducing the occurrence of postoperative complications. Key words: Brain neoplasms; Microsurgery; Eloquent area; Virtual reality; Multimodel