TECHNICAL NOTE J Neurosurg 127:139–147, 2017 H emangioblastoma is a rare benign tumor of the CNS that often occurs in the posterior fossa. Al- though stereotactic radiosurgery has proven to be effective in some cases, 6,9 microsurgical resection still re- mains the gold-standard treatment option. Successful re- section of the tumor depends on early interruption of the arterial blood supply, frst of the feeding arteries and then of the draining veins. 2,4,5,7,8 Therefore, the key to successful treatment is to preoperatively assess the number of feed- ing arteries, the courses of the feeding arteries, and the point where the feeding arteries penetrate the tumor, thus establishing the precise locations of the feeding arteries in the actual operation feld. 19,22 Conventional angiography is useful for the preoperative assessment, 10,17–19 provid- ing precise information about the blood vessels, includ- ing the feeding arteries and draining veins, but can give little information about the tumor and surrounding brain structures. Therefore, the exact relationship between these vessels and the surrounding structures such as the tumor and brainstem is diffcult to estimate. To estimate the pre- cise locations of the feeding arteries in the actual operative feld, simultaneous 3D visualization of the feeding arteries and the surrounding structures is needed. Three-dimensional multifusion medical imaging (3DMMI) was recently reported to be useful in the com- prehension of complicated anatomical relationships and surgical simulations, 15,16,20,23 because this technique can si- multaneously provide 3D information of multiple anatomi- cal structures. However, even 3D medical imaging cannot always identify the exact location of each feeding artery, 23 ABBREVIATIONS AICA = anterior inferior cerebellar artery; CTA = CT angiography; DSA = digital subtraction angiography; FIESTA = fast imaging employing steady-state acquisition; hr-3DMMI = high-resolution 3D multifusion medical imaging; MRA = MR angiography; TOF = time of flight; TRICKS = time-resolved imaging of contrast kinetics; 3DRA = 3D rotated angiography. SUBMITTED November 16, 2015. ACCEPTED May 27, 2016. INCLUDE WHEN CITING Published online August 26, 2016; DOI: 10.3171/2016.5.JNS152646. Usefulness of high-resolution 3D multifusion medical imaging for preoperative planning in patients with posterior fossa hemangioblastoma: technical note Masanori Yoshino, MD, PhD, 1 Hirofumi Nakatomi, MD, PhD, 1 Taichi Kin, MD, PhD, 1 Toki Saito, PhD, 2 Naoyuki Shono, MD, 1 Seiji Nomura, MD, 1 Daichi Nakagawa, MD, 1 Shunsaku Takayanagi, MD, PhD, 1 Hideaki Imai, MD, PhD, 1 Hiroshi Oyama, MD, PhD, 2 and Nobuhito Saito, MD, PhD 1 Departments of 1 Neurosurgery and 2 Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, Japan Successful resection of hemangioblastoma depends on preoperative assessment of the precise locations of feeding arteries and draining veins. Simultaneous 3D visualization of feeding arteries, draining veins, and surrounding structures is needed. The present study evaluated the usefulness of high-resolution 3D multifusion medical imaging (hr-3DMMI) for preoperative planning of hemangioblastoma. The hr-3DMMI combined MRI, MR angiography, thin-slice CT, and 3D rotated angiography. Surface rendering was mainly used for the creation of hr-3DMMI using multiple thresholds to create 3D models, and processing took approximately 3–5 hours. This hr-3DMMI technique was used in 5 patients for preoperative planning and the imaging fndings were compared with the operative fndings. Hr-3DMMI could simulate the whole 3D tumor as a unique sphere and show the precise penetration points of both feeding arteries and draining veins with the same spatial relationships as the original tumor. All feeding arteries and draining veins were found intraopera- tively at the same position as estimated preoperatively, and were occluded as planned preoperatively. This hr-3DMMI technique could demonstrate the precise locations of feeding arteries and draining veins preoperatively and estimate the appropriate route for resection of the tumor. Hr-3DMMI is expected to be a very useful support tool for surgery of hemangioblastoma. https://thejns.org/doi/abs/10.3171/2016.5.JNS152646 KEY WORDS hemangioblastoma; high-resolution 3D multifusion medical imaging; technique; feeding artery; draining vein; preoperative planning; oncology ©AANS, 2017 J Neurosurg Volume 127 • July 2017 139 Unauthenticated | Downloaded 05/18/22 04:31 PM UTC