Surgical planning

Pre-operative analysis from the week-156 scan immediately before Patient-067's fourth resection. The 3-D view uses her measured tumor and brain geometry. Extent of resection, depth and cranial access can be varied; postoperative behavior is referenced to her three earlier observed resections, with the fourth postoperative course shown separately for comparison.

Immediately after resection

—

Selected resection plan

Drag the white access point across the brain surface, or tap to place it · drag elsewhere to rotate

Approach clear of the flagged zonesBorderlineCrosses a flagged zoneWhite circle: approximate 3-cm cranial access centered on the entry pointLine: trajectory to the tumorRed patches: access-constraint zones

Weeks after resection0

Pre-operative state

Week 156 scan: progressive disease, total .

Observed course: resection, then a week 157 post-operative scan measuring .

1 · Extent of resection

These buttons set the resection objective. The resulting category is calculated below from residual contrast-enhancing volume using the RANO resect classes (2023), which use absolute postoperative residual volume: class 2A, no residual contrast-enhancing tumor; 2B, ≤1 cm³; 3A, >1 to ≤5 cm³; 3B, >5 cm³. Class 1 (supramaximal) also requires judging residual T2/FLAIR abnormality as tumor rather than postoperative edema or ischemia, which the segmentation's edema label cannot do, so it is not assigned here. Aim and achievement differ, as they do in practice.

Extent of resection attempted0.70Fraction of the intended resection achieved.

2 · Surgical trajectory

Cranial access: position around the head108° Cranial access: height35°Fine adjustment. You can also drag or tap the access point on the brain surface; the trajectory runs from the selected access point to the tumor.

3 · Residual tumor after resection

	Week 156	This configuration	Observed wk 157
Enhancing
Necrotic
Edema / FLAIR
Total

"Observed" is the post-operative scan one week after resection. In that scan the cavity and blood products are counted as necrotic, which is why that value rises.

Contrast-enhancing tumor removed

Residual contrast-enhancing tumor

Residual T2/FLAIR abnormality (edema label, not classified as tumor)

RANO resect category achieved

Regrowth adjacent to the resection cavity

Tissue crossed by the approach

Post-operative course over 24 weeks (cm³)

TotalEnhancingShaded: range of her own responses to operations 1–3◆ Observed scans (weeks 157 and 167)

Method and provenance

What the ratings do not include. RANO requires a stable or decreasing corticosteroid dose for a response to count. RANO 2.0 requires confirmation of objective response (after at least four weeks) and requires or recommends confirmation of progression in specified settings, particularly within 12 weeks of radiotherapy because of pseudoprogression. LUMIERE records neither steroid dose nor confirmation status. The ratings shown are the source dataset’s expert RANO labels and have not been re-adjudicated under RANO 2.0; read them as imaging assessments only.
Zoom and cut-away (pinch, the + and − buttons, or the mouse wheel after clicking the view; ◐ slices the tumor open) enlarge the current 3-D view to show how its compartments nest. They do not reveal detail finer than the MRI, whose resolution is on the millimetre scale.
Cells (✺ switches between cells and measurement dots) are illustrative renderings in the style of fluorescence microscopy, not imaged cells. Magenta cells are tumor cells: rounded in the tumor body, elongated where they infiltrate the surrounding edema, and shown dividing at a rate that rises when the enhancing tumor is growing. Grey, fragmenting cells are dying; they increase when the enhancing tumor shrinks or the necrotic core grows. Pale blue cells with branching processes are healthy brain cells around and among the infiltrating tumor cells. Infiltrating cells spread outward faster when edema is growing. The rates come from the displayed volumes (observed between scans, or calculated in the intervention analyses); the line under the legend states them. Zooming in brings the cells forward and fades the outlines.
Starting state: measured LUMIERE Patient-067 compartments at week 156 (progressive disease). The observed post-operative scans at week 157 (1 week after resection) and week 167 (11 weeks after) are shown for comparison only; neither was used to set the earlier-resection response calculation.
Patient anatomy. The 3-D body is Patient-067's measured week-156 tumor anatomy, reconstructed from LUMIERE's atlas-space DeepBraTumIA segmentation and simplified for display. The cut follows the selected access trajectory; the resection calculation removes tissue from that measured geometry. The Geometry control can switch to equivalent-volume geometry.
Access constraints. LUMIERE does not provide patient-specific functional mapping or tractography. The red surface patches therefore serve only as access-constraint placeholders for exercising trajectory and resection controls; they are not patient-specific eloquent-cortex or tract labels.
Removal fraction is determined by extent and depth and is reduced when the selected trajectory intersects a flagged access-constraint zone. Wider and deeper resections increase the corridor score; the current thresholds classify the route as clear (<0.22), borderline (<0.36), or flagged.
Measured anatomy. The 3-D view uses Patient-067's week-156 tumor compartments and brain surface reconstructed from LUMIERE's atlas-space DeepBraTumIA segmentation. The selected resection calculation follows the chosen access trajectory and updates compartment volumes around their measured centroids. The Geometry control provides an equivalent-volume comparison view.
Post-operative course. The response calculation is referenced to this patient's recorded enhancing-tumor changes after her first three resections (weeks 0, 19 and 59); the shaded band spans those observed responses and the line weights the most recent response most heavily. Her fourth resection is excluded from that calculation and its week-157 and week-167 scans are shown separately for comparison. The observed recurrence by week 167 was faster than the calculation based on the earlier resections.
The search tries all extents, depths and directions in 5° steps and returns the largest removal that stays clear.