Different techniques of performing image-guided neurosurgery exist, namely, neuronavigation systems, intraoperative ultrasound, and intraoperative MRI, each with its limitations. Except for ultrasound, other methods are expensive. Three-dimensional virtual reconstruction and surgical simulation using 3D volume rendering (VR) is an economical and excellent technique for preoperative surgical planning and image-guided neurosurgery. In this article, the authors discuss several nuances of the 3D VR technique that have not yet been described.

The authors included 6 patients with supratentorial gliomas who underwent surgery between January 2019 and March 2021. Preoperative clinical data, including patient demographics, preoperative planning details (done using the VR technique), and intraoperative details, including relevant photos and videos, were collected. RadiAnt software was used for generating virtual 3D images using the VR technique on a computer running Microsoft Windows.

The 3D VR technique assists in glioma surgery with a preoperative simulation of the skin incision and craniotomy, virtual cortical surface marking and navigation for deep-seated gliomas, preoperative visualization of morbid cortical surface and venous anatomy in surfacing gliomas, identifying the intervenous surgical corridor in both surfacing and deep-seated gliomas, and pre- and postoperative virtual 3D images highlighting the exact spatial geometric residual tumor location and extent of resection for low-grade gliomas (LGGs).

Image-guided neurosurgery with the 3D VR technique using RadiAnt software is an economical, easy-to-learn, and user-friendly method of simulating glioma surgery, especially in resource-constrained countries where expensive neuronavigation systems are not readily available. Apart from cortical sulci/gyri anatomy, FLAIR sequences are ideal for the 3D visualization of nonenhancing diffuse LGGs using the VR technique. In addition to cortical vessels (especially veins), contrast MRI sequences are perfect for the 3D visualization of contrast-enhancing high-grade gliomas.

存在执行图像引导神经外科手术的不同技术，即神经导航系统、术中超声和术中 MRI，每种技术都有其局限性。除了超声波，其他方法都很昂贵。使用 3D 体积渲染 (VR) 的三维虚拟重建和手术模拟是一种经济且出色的术前手术计划和图像引导神经外科技术。在本文中，作者讨论了尚未描述的 3D VR 技术的几个细微差别。

作者纳入了 2019 年 1 月至 2021 年 3 月期间接受手术的 6 名幕上胶质瘤患者。 收集了术前临床数据，包括患者人口统计数据、术前计划细节（使用 VR 技术完成）和术中细节，包括相关照片和视频。RadiAnt 软件用于在运行 Microsoft Windows 的计算机上使用 VR 技术生成虚拟 3D 图像。

3D VR 技术通过术前模拟皮肤切口和开颅手术、对深部神经胶质瘤进行虚拟皮质表面标记和导航、术前可视化病态皮质表面和表面神经胶质瘤的静脉解剖、识别血管内的介入手术通道来辅助神经胶质瘤手术。表层和深部神经胶质瘤，以及术前和术后虚拟 3D 图像，突出显示了低级别胶质瘤 (LGG) 的精确空间几何残留肿瘤位置和切除范围。

使用 RadiAnt 软件通过 3D VR 技术进行图像引导的神经外科手术是一种经济、易于学习且用户友好的模拟神经胶质瘤手术的方法，特别是在资源有限的国家，这些国家/地区无法使用昂贵的神经导航系统。除了皮质脑沟/脑回解剖结构外，FLAIR 序列是使用 VR 技术对非增强弥漫性 LGG 进行 3D 可视化的理想选择。除了皮质血管（尤其是静脉），对比 MRI 序列非常适用于增强对比的高级神经胶质瘤的 3D 可视化。