A Virtual Reality System for Neurosurgery: Integrated Brain Tumor With Peri-tumoral Neuroanatomy

Introduction In neurosurgery, the relationship among tumor mass and peri-tumoral structures including peri-tumoral edema are important for planning surgical trajectory and crucial for diagnosis, tumor excision, and post-surgical outcome [1]. Conventionally, T2WI and Gadolinium(Gd)-T1WI provide the information of, tumor mass, and peri-tumoral edema. The recent development of diffusion tensor MRI (DTI) has shown its feasibility in grading tumor [2], monitoring therapeutic effects [3], and clinical outcome [4]. Furthermore, DTI also provides the anatomical information of peri-tumoral microstructures, which might be deviated, infiltrated, and destroyed by a brain tumor [5]. Virtual reality (VR) is a powerful technique that can provide 3D display and even interaction between operators [6, 7]. In this study, a VR environment for integrating neuroanatomy was developed. It was aimed to clarify the relationship between tumor mass, peri-tumoral edema and brain tissues, and surrounding neural tracts derived from DTI for facilitating neurosurgical trajectory design and optimizing therapeutic outcome.