3D Reconstruction-Guided Brain Lesion Resection Based on Adjacent Landmarks: Concepts and a Usability Study.

[OBJECTIVE] To evaluate the effect of three dimensional (3D) reconstruction-guided brain lesion resection based on adjacent landmarks.

[METHODS] Between January 2019 and June 2022, 13 patients with brain lesions underwent 3D reconstruction-guided microsurgery using adjacent landmarks. The study was approved by the Ethics Board of the Third Affiliated Hospital of Sun Yat-sen University. Preoperative planning utilized 3D Slicer for reconstructing and fusing multimodal imaging, with entry points and trajectories localized via adjacent anatomical structures (sulci, gyri, vessels, and nerves). Surgical procedures (positioning, incision, and bone window creation) followed the plan, and lesion resection was guided by 3D virtual models.

[RESULTS] All preoperative plans were finalized the day before surgery, with a mean reconstruction and fusion time of less than 2 hours. Intraoperative lesion localization was accurately achieved through 3D reconstruction-assisted visual guidance. Entry points and approaches for deep lesions were guided by adjacent vessels and brain surface morphology, all of which were clearly identified. Postoperative imaging revealed complete resection in all cases except one low-grade glioma in the precentral gyrus. Seven patients had no new neurological deficits, one experienced transient speech impairment, and 2 had limb weakness that resolved during follow-up.

[CONCLUSIONS] 3D reconstruction-guided resection of brain lesions using adjacent anatomical landmarks reduces procedural costs, optimizes surgical planning, and ensures precise execution. This approach accelerates the learning curve for novice neurosurgeons and enhances the quality and safety of surgery.