Intraoperative brain shift prediction using a 3D inhomogeneous patient-specific finite element model.

OBJECT The aims of this study were to develop a three-dimensional patient-specific finite element (FE) brain model with detailed anatomical structures and appropriate material properties to predict intraoperative brain shift during neurosurgery and to update preoperative magnetic resonance (MR) images using FE modeling for presurgical planning. METHODS A template-based algorithm was developed to build a 3D patient-specific FE brain model. The template model is a 50th percentile male FE brain model with gray and white matter, ventricles, pia mater, dura mater, falx, tentorium, brainstem, and cerebellum. Gravity-induced brain shift after opening of the dura was simulated based on one clinical case of computer-assisted neurosurgery for model validation. Preoperative MR images were updated using an FE model and displayed as intraoperative MR images easily recognizable by surgeons. To demonstrate the potential of FE modeling in presurgical planning, intraoperative brain shift was predicted for two additional head orientations. Two patient-specific FE models were constructed. The mesh quality of the resulting models was as high as that of the template model. One of the two FE models was selected to validate model-predicted brain shift against data acquired on intraoperative MR imaging. The brain shift predicted using the model was greater than that observed intraoperatively but was considered surgically acceptable. CONCLUSIONS A set of algorithms for developing 3D patient-specific FE brain models is presented. Gravity-induced brain shift can be predicted using this model and displayed on high-resolution MR images. This strategy can be used not only for updating intraoperative MR imaging, but also for presurgical planning.