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Preoperative interactive virtual simulation applying three-dimensional multifusion images using a haptic device for lumbosacral lipoma

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Abstract

Purpose

Untethering surgery for lumbosacral lipoma is a preventive procedure, and avoidance of complications and good long-term outcomes are required. We introduced presurgical interactive virtual simulation (IVS) applying three-dimensional multifusion images using a haptic device aimed at improving operative outcomes.

Methods

Fourteen patients with newly diagnosed lumbosacral lipoma were recruited and underwent preoperative IVS. The median age at surgery was 8 months. A three-dimensional image analysis system was used to extract and fuse structures necessary for surgery, such as the lipoma, spinal cord and skin, from CT and MRI, and create three-dimensional multifusion images. The created images were individually converted to standard triangulated language format and loaded onto a workstation (Geomagic freeform™) that could be freely transformed, and the laminectomy range and lipoma extraction procedure were examined. Presurgical IVS was performed, and the actual surgery was performed.

Results

The disease types were dorsal, caudal, lipomyelomeningocele, transitional, and filum in 5, 5, 2, 1, and 1 patients, respectively. The surgical procedure and extent of the laminectomy were as planned for all patients. Resection of the lipomas tended to be less than expected preoperatively because of positive reactions on intraoperative monitoring. No postoperative complications were observed. The median postoperative follow-up period was 29 months, and there were no reoperations during the observation period.

Conclusions

Although there are various types of lumbosacral lipoma, surgery can be safely performed by performing presurgical IVS. The short-term course is good; however, long-term follow-up is necessary for the appearance of neurological symptoms associated with growth and re-tethering.

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Acknowledgements

The authors thank Yoshiyuki Noto, Tatsuya Kuramoto and Hiroaki Saito, Department of Radiological Technology, Niigata University Hospital, for their technical assistance.

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Authors and Affiliations

  1. Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-ku, Niigata, 951-8585, Japan

    Ryosuke Ogura, Hidemoto Fujiwara, Manabu Natsumeda, Tetsuya Hiraishi & Makoto Oishi

  2. Department of Neurosurgery, Toyama Prefectural Central Hospital, Toyama, Japan

    Masakazu Sano

Authors
  1. Ryosuke Ogura
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  2. Hidemoto Fujiwara
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  3. Manabu Natsumeda
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  4. Tetsuya Hiraishi
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  5. Masakazu Sano
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  6. Makoto Oishi
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Contributions

R.O. and M.O. conceived the idea of the study. R.O. and M.N. wrote the main manuscript text and prepared Figs. 1, 2 and 3. F.H., T.H. and M.S. contributed to the interpretation of the results. M.O. supervised the conduct of this study. All authors critically reviewed and revised the manuscript draft and approved the final version for submission.

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Correspondence to Ryosuke Ogura.

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The authors declare no competing interests.

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Ogura, R., Fujiwara, H., Natsumeda, M. et al. Preoperative interactive virtual simulation applying three-dimensional multifusion images using a haptic device for lumbosacral lipoma. Childs Nerv Syst 40, 1129–1136 (2024). https://doi.org/10.1007/s00381-023-06234-2

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