• Philip A Glemser, Klaus Engel, David Simons, Johann Steffens, Heinz-Peter Schlemmer, and Berk Orakcioglu.
• Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany. Electronic address: p.glemser@dkfz.de.
• World Neurosurg. 2018 Jun 1; 114: e283-e292.

ObjectiveClassical single-colored or multicolored 3-dimensional (3D) visualization of sectional images lacked in being realistic and revealed limited anatomical discrimination. Recently, a new technique called cinematic volume rendering for 3D reconstruction of computed tomography has been developed. The aim of this study was to analyze this new visualization algorithm from a technical perspective and to investigate potential benefits for neurosurgical applications.MethodsA standard test in computer graphics called Cornell Box was adapted and applied for reproducibility of light effects in cinematic rendering opposed to classic rendering methods. Simulation of distinct camera effects such as variable apertures, exposition time, optics, and surface refinements are presented in a human skull, respectively. Postprocessing capabilities allow for immediate clinical use.ResultsThis volume-rendering technique generates cadaver-like 3D reconstructions. By considering complex interactions between a scanned object and dynamic light patterns, a cinematic illumination of a 3D surface reconstruction can be achieved. A spinal tumor case and a complex intracranial carotid artery aneurysm are presented, comparing all available rendering techniques. Cinematic rendering results in greater spatial discrimination of neighboring anatomical structures.ConclusionsThis technical and clinical description focuses on the neurosurgical relevance of a new rendering technique. Considering the improved image impression of cinematic rendering and viewers' perception, it seems likely that the technique will gain wide acceptance in the clinical routine.Copyright © 2018 Elsevier Inc. All rights reserved.

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