University of Twente Student Theses


MRI based 3D models as aiding tool for Parotid Gland Surgery

Moll, M.C.M. (2023) MRI based 3D models as aiding tool for Parotid Gland Surgery.

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Abstract:Patients with a parotid gland tumour undergo surgical treatment in the form of a parotidectomy. During surgery it is of utmost importance to spare the facial nerve. However, preoperatively the precise location of the tumour in relation to the facial nerve is unknown. Although facial nerve monitoring is employed during surgery, there remains a risk of immediate or permanent facial nerve weakness. Such dysfunction can have a significant impact on a patient's quality of life. It is hypothesised that three-dimensional visualisation of the spatial relation between the tumour and facial nerve can aid in facial nerve management. With this innovation, the risk for facial nerve damage can be better estimated during preoperative planning. Additionally, it can enable a precise assessment of the surgical complexity and facilitate improved patient communication regarding potential complications. This thesis introduces and assesses a method to visualize the facial nerve in 3D based on the NerveVIEW MRI sequence within a patient study. Chapter 1 gives an introduction to the clinical background of parotid gland tumour and the surgical treatment. It discusses the clinical problem, proposed solution with technical background, and objectives. The systematic review in Chapter 2 gives an overview of currently used MRI sequences and segmentation methods of cranial nerves. Many cranial nerves can now be visualized, and some hospitals incorporate 3D models of cranial nerves into clinical care. Besides the use 3D models during pre-operative planning, they are also valuable during patient counselling. This chapter provides a comprehensive assessment of existing literature as a foundation for future studies. In Chapter 3, the method to visualise the facial nerve in patients with a parotid tumour is described and assessed. With the NerveVIEW sequence, the facial nerve in patients with a parotid gland tumour can be visualised. Our findings indicate a concordance between the preoperative MRI-derived model of the facial nerve, including the trunk, pes anserinus, and the upper and lower divisions of the facial nerve. Chapter 4 delves into three visualization modalities (3D visualization on a 2D screen, 3D printed model, and augmented reality visualization) for the facial nerve models from Chapter 3. The preferred modality is found to be visualization on a 2D screen. Chapter 5 explores the influence of the parotid gland's fat fraction on the visibility of the facial nerve trunk. Using the mDIXON Quant and NerveVIEW imaging techniques, the study observes an increase in the contrast-to-noise ratio of the facial nerve trunk on both sides in correlation with the fat fraction. An overall conclusion and future perspectives is offered in Chapter 6. Although the preliminary results are promising, the NerveVIEW sequences can be further optimised and evaluated in a clinical trial to study the clinical implications of these models for surgeon, patients, and daily clinical practice.
Item Type:Essay (Master)
Antoni van Leeuwenhoek - NKI, Amsterdam, Nederland
Faculty:TNW: Science and Technology
Subject:33 physics, 44 medicine
Programme:Technical Medicine MSc (60033)
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