To explore the application value of image post-processing technology based on image fusion and three-dimensional surface reconstruction in the treatment of intracranial arteriovenous malformations (AVM).

A total of 21 patients with intracranial AVM underwent surgical treatment at Neurosurgery Department, the First Affiliated Hospital of Soochow University from January 2018 to December 2019 and their clinical data were retrospectively analyzed. All patients underwent the examinations of preoperative CT, 3.0T MRI and 3D-DSA. Multimodal images were then co-registered with software iplan, followed by three-dimensional image reconstruction to generate preoperative models. The location and range of AVM, relationship to eloquent area, and locations of feeding artery and draining vein were evaluated based on the model and compared with intra-operative findings. The AVM was resected under craniotomy microscope. Head MRI and DSA were followed up post operation, as well as the patient’s limb movement, language function and vision.

For all 21 patients, preoperative model reconstruction was successfully made. The location of AVM, eloquent area, feeding artery and draining vein were identified during operation using the model. Comparison could not be performed in one case, because there was no obvious large blood vessel in the operative field, and the hematoma in the brain caused compression on the brain sulcus and unclear shape of the gyri. The rate of consistency between preoperative modeling and intraoperative findings was 95.2% (20/21). Among the 21 patients, total resection was performed in 20 cases and subtotal resection in 1. Of the 5 patients with hemiplegia caused by AVM bleeding before operation, 4 recovered within 3 months. One patient with hemianopsia due to bleeding before operation reported improvement of the visual field at 3 months after operation. Postoperative dysfunction of limb movement was observed in 1 case because of rebleeding after the first surgery who and recovered to normal in 2 weeks. For 21 patients, the follow-up lasted for 15.8±6.7 months (3-25 months) and there was no case of rebleeding. Among the 4 patients with epileptic seizure as the initial symptom, 3 had no seizure after operation and 1 still had seizures within 3 months after surgery. The seizure stopped following the adjustment of antiepileptic drugs.

The technology of image post-processing can help to make an accurate assessment of the position and range of AVM, its relationship to functional area, the location of feeding arteries and drainage veins before surgery, which can improve the total resection rate of AVM and reduce the occurrence of postoperative complications.

Intracranial arteriovenous malformations; Neurosurgical procedures; Imaging, three-dimensional; Image post-processing; Image fusion