Three-Dimensional Computed Tomographic Reconstruction: Planning Tool for Surgery of Skull Base Pathologies

Three-dimensional (3-D) computed tomographic (CT) reconstruction of the skull base region has added a different perspective to the data set usually presented in axial or coronal slices. It simultaneously demonstrates the spatial relationship of bones, tumors, vessels, and ventricles in a single illustration. Forty-nine patients with skull base lesions (44 with neoplastic and 5 with vascular pathologies) were examined with a spiral CT and 3-D reconstruction prior to surgery. A scanner and a maximum of 95 mL of iodized contrast media were used to enhance either tumor or vessels according to the specific pathology. Preoperative 3-D reconstruction was performed. It rendered a spatial representation of the pathology using data similar to that usually acquired in routine preoperative diagnostics. Complex anatomy can be visualized with only a handful of pictures. It was possible to easily compare various surgical approaches to the lesion on the basis of the 3-D computer model and to simulate the surgeon's view. The short time span (1 h average) necessary for reconstruction and editing allows the application of this method as a routine preoperative procedure for selected skull base pathologies.