Presurgical Planning with Open-Source Horos Software for Superficial Brain Arteriovenous Malformations

Mauricio Mandel; Yiping Li; Eberval Gadelha Figueiredo; Manoel Jacobsen Teixeira; Gary Kenneth Steinberg

doi:10.1016/j.wneu.2021.09.081

Presurgical Planning with Open-Source Horos Software for Superficial Brain Arteriovenous Malformations

World Neurosurg. 2022 Jan:157:3-12. doi: 10.1016/j.wneu.2021.09.081. Epub 2021 Sep 25.

Authors

Mauricio Mandel¹, Yiping Li², Eberval Gadelha Figueiredo³, Manoel Jacobsen Teixeira³, Gary Kenneth Steinberg⁴

Affiliations

¹ Department 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.
² Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine and Stanford Health Care, Stanford, California, USA.
³ Department of Neurosurgery, Hospital das Clinicas of University of São Paulo Medical School, São Paulo, Brazil.
⁴ Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine and Stanford Health Care, Stanford, California, USA. Electronic address: gsteinberg@stanford.edu.

PMID: 34582999
DOI: 10.1016/j.wneu.2021.09.081

Abstract

Background: Surgical planning for treating brain arteriovenous malformations (bAVMs) is challenging because it entails visualizing 3-dimensional (3D) relationships between the nidus, its feeding and en passage arteries, and draining veins. Surgical experience in developing the capacity to mentally visualize pathological bAVM angioarchitecture could be complemented by this software, and thus potentially lower the steep learning curve for understanding complex bAVM angioarchitecture. We evaluated the clinical application of freely available online 3D reconstruction software in facilitating visualization of AVM angioarchitecture for presurgical planning.

Methods: Preoperative Digital Imaging and Communications in Medicine magnetic resonance imaging/magnetic resonance angiography images of 56 superficial bAVMs from 2013 to 2018 were processed using open-source software Horos. 3D rendered images were compared with the surgical view to evaluate software accuracy and determine its value as a preoperative tool. 3D reconstructed images were compared with intraoperative recordings.

Results: A useful image identifying both the main feeding artery and draining vein was achieved in 35 of 56 cases (62.5%). Reconstructions of small AVMs (nidus ≤2 cm) and those located within the temporal or cerebellar cortex were less useful due to soft tissue artifacts. Frontal and parietal lobe lesions had significantly higher rates of identifying feeding arteries and draining veins (P < 0.05).

Conclusion: Presurgical planning for resection of superficial bAVMs using Horos software allows for a comprehensive 3D analysis of the bAVM angioarchitecture. This technique is most useful for frontal and parietal lobe lesions, and aids the surgeon in formulating an optimal surgical strategy. The 3D reconstruction of the brain surface offers a surgical map not influenced by brain shift.

Keywords: 3D reconstruction; Brain arteriovenous malformation; Cortical arterial anatomy; Cortical venous anatomy; Horos.

MeSH terms

Adolescent
Adult
Aged
Angiography, Digital Subtraction
Cerebral Angiography
Cerebral Arteries / diagnostic imaging
Cerebral Arteries / surgery
Cerebral Veins / diagnostic imaging
Cerebral Veins / surgery
Child
Child, Preschool
Female
Humans
Image Processing, Computer-Assisted
Imaging, Three-Dimensional
Intracranial Arteriovenous Malformations / diagnostic imaging*
Intracranial Arteriovenous Malformations / surgery*
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Male
Middle Aged
Neurosurgical Procedures / methods*
Patient Care Planning*
Reproducibility of Results
Software*
Young Adult