A 35 year-old female presented with a right neck mass that she noticed 5 months previously. The tumor was approximately 3 × 3 cm and was initially discovered due to a work-up for a stroke. A contrast-enhanced neck CT showed a 2.5 × 2.5 cm tumor at the right carotid artery bifurcation (Fig. a). The tumor surrounded the initial segment of internal and external carotid artery, with circumferential collateral vessels consistent with a carotid body tumor. CTA confirmed right common, internal and external carotids supplying the tumor (Fig. b). Preoperative VR technique was used to make individual models and to perform preoperative simulation of the anticipated resection (Fig. c). The unique perspective of using VR technology to view the blood vessels, called “intravascular peep”, clearly demonstrates vascular compression or vascular invasion (Fig. d, e). After optimizing the preoperative planning, the patient underwent right carotid body tumor resection. VR allowed the surgeon to practice the gradual separation of the tumor at the carotid bifurcation.
A 53 year-old female presented with a left neck mass. Her past medical history is significant for recurrent breast cancer that required multiple surgeries including radical mastectomy and two courses of chemoradiotherapy. Three years prior to presentation, a mass was found in her left neck. A needle biopsy demonstrated malignant fibrous histiocytoma. Imaging with CT and MRI were obtained and shown in Fig. a, b. Following preoperative physical examination and imaging, VR was used to simulate the operation. The CT and MRI data were collected and converted into DICOM format. The DICOM image was tested to ensure that the image meets quality standards. The DICOM images were used to perform a three dimensional reconstruction of the area of anticipated resection. Multimodal image fusion of CT and MRI was performed using precision detection by medical imaging experts. The multimodal 3D reconstruction model was transformed into VR model, with color coding of important structures, blood vessels, nerves, bone and tumor for convenient recognition. This model is imported into the UE4 engine to take advantage of function customization. After settling cluster rendering equipment and 3D scanner, surgeons wear head mounted display and data gloves for surgical simulation to pick up and rotate the model, or to change functions such as zoom, model resolution, and profile in the virtual operation room (Fig. c). Following use of the VR with multiple sessions, the patient underwent extended excision of left cervical and thoracic junction tumor with partial left clavicle resection, left subclavian vein repair, and pectoralis major myocutaneous flap repair under general anesthesia.