Importance of Veins for Neurosurgery as Landmarks Against Brain Shifting Phenomenon: An Anatomical and 3D-MPRAGE MR Reconstruction of Superficial Cortical Veins

Santino Ottavio Tomasi; Giuseppe Emmanuele Umana; Gianluca Scalia; Roberto Luis Rubio-Rodriguez; Pier Francesco Cappai; Crescenzo Capone; Giuseppe Raudino; Bipin Chaurasia; Maurizio Salvati; Nicolas Jorden; Peter A Winkler

doi:10.3389/fnana.2020.596167

Importance of Veins for Neurosurgery as Landmarks Against Brain Shifting Phenomenon: An Anatomical and 3D-MPRAGE MR Reconstruction of Superficial Cortical Veins

Front Neuroanat. 2020 Dec 15:14:596167. doi: 10.3389/fnana.2020.596167. eCollection 2020.

Authors

Santino Ottavio Tomasi^{1

2

3}, Giuseppe Emmanuele Umana⁴, Gianluca Scalia⁵, Roberto Luis Rubio-Rodriguez^{6

7

8}, Pier Francesco Cappai⁹, Crescenzo Capone¹⁰, Giuseppe Raudino¹¹, Bipin Chaurasia¹², Maurizio Salvati¹³, Nicolas Jorden¹⁴, Peter A Winkler^{1

2

3}

Affiliations

¹ Department of Neurological Surgery, Christian Doppler Klinik, Salzburg, Austria.
² Paracelsus Medical University, Salzburg, Austria.
³ Laboratory for Microsurgical Neuroanatomy, Christian Doppler Klinik, Salzburg, Austria.
⁴ Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy.
⁵ Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibald", Catania, Italy.
⁶ Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, CA, United States.
⁷ Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.
⁸ Department of Otolaryngology- Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, United States.
⁹ Department of Neurosurgery, Azienda Ospedaliera G. Brotzu, Universitá degli Studi di Sassari, Sassari, Italy.
¹⁰ Department of Peripheral Nerve Surgery, Azienda Unità Sanitaria Locale Romagna, Ospedale Civile di Faenza, Faenza, Italy.
¹¹ Department of Neurosurgery, Istituto di Ricovero e Cura ad Alta Specializzazione Policlinico di Monza, Monza, Italy.
¹² Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal.
¹³ Department of Neurosurgery, Policlinico Tor Vergata, Rome, Italy.
¹⁴ Radiologie und Nuklearmedizin Dachau, Karlsfeld, Germany.

Abstract

Modern neurosurgery uses preoperative imaging daily. Three-dimensional reconstruction of the cortical anatomy and of the superficial veins helps the surgeons plan and perform neurosurgical procedures much more safely. The target is always to give the patient maximum benefit in terms of outcome and minimize intraoperative and postoperative complications. This study aims to develop a method for the combined representation of the cerebral cortex anatomy and the superficial cerebral veins, whose integration is beneficial in daily practice. Only those patients who underwent surgical procedures with craniotomy and a large opening of the dura mater were included in this study, for a total of 23 patients, 13 females (56.5%) and 10 males (43.5%). The average age was 50.1 years. We used a magnetic resonance tomograph Magnetom Vision® 1.5T (Siemens AG). Two sequences were applied: a strongly T1-weighted magnetization-prepared rapid acquisition with gradient echo (MPRAGE) sequence to visualize cerebral anatomical structures, and a FLASH-2D-TOF angiography sequence to visualize the venous vessels on the cortical surface after the administration of a paramagnetic contrast agent. The two data sets were superimposed manually, co-registered in an interactive process, and merged to create a combined data set, segmented and visualized as a three-dimensional reconstruction. Furthermore, we present our method for visualizing superficial veins, which helps manage brain shift (BS). We also performed anatomical observations on the reconstructions. The reconstructions of the cortical and venous anatomy proved to be a valuable tool in surgical planning and positively influenced the surgical procedure. Due to the good correlation with the existing surgical site, this method should be validated on a larger cohort or in a multicentric study.

Keywords: 3D reconstruction; MPRAGE MR-sequences; brain shift; microsurgical neuroanatomy; superficial cortical veins.