Virtual Operative Neurosurgical Anatomy: Introduction of a New Interactive Paradigm

Commentary

The intricacies of cranial and cerebral anatomy have been the fascination of generations since the Middle Ages with attempts to figuratively represent these structures in increasing anatomical detail for the purposes of education, clinical application, and fascination. The initial renditions of cranial anatomy were represented by two-dimensional (2D) schematics of the ventricular system surrounded by disorganized neural tissue.¹Increasingly sophisticated and innovative 2D schematics have been developed by physicians, anatomists, and illustrators through the ages to advance anatomical and surgical understanding of the intricacies of cranial anatomy. The recent advances in graphic design and computer animation have provided a new environment that can not only be highly accurate but also be potentially revolutionary for interactive 3D anatomical representation.

Within the realm of surgical education, anatomical relationships have to be mentally converted from 2D into 3D space for clinical and surgical applications. The design of 3D anatomical representations began in the late 1980s and evolved with the development of computer graphics ^2,3and has an established presence in the neurosurgical literature. The next 3D modelling development was achieved with the introduction of the Visible Human Project to create a complete 3D representation of a male and female human body for the purpose of education.^2,4

Evolution of 3D modelling in neurosurgery has involved surgical planning for temporal lobectomy,⁵cerebral aneurysm clipping,^6,7transpetrous surgical approach,⁸temporal bone dissection,^9,10and posterior fossa surgical planning.¹¹Educational models that have been created include an interactive 3D virtual model of the temporal bone^12-17and 3D cerebrovascular atlas¹⁸. These models provide a unique perspective on the presented anatomy unparalleled by the existing 2D representations of neuroanatomy.

The following series of articles from the Neurosurgical Atlas in the upcoming issues of the Operative Neurosurgery will introduce interactive 3D models that provide an immersive third dimension of both normal and pathological neurosurgical anatomy. These models are the result of 5 years of intense computerized sculpting work by The Neurosurgical Atlas team to create exceptionally detailed interactive virtual specimens that hopefully will provide an unparalleled realism (Model 1).

The neurosurgical operating room has also been created in this virtual environment and will be presented in the near future (Model 2). We sincerely hope that the viewers will find this new interactive environment helpful in their understanding of cranial anatomy and operative neurosurgery for educational, illustrative, and surgical training purposes.

References

1. Sutherland-Foggio, H., Developing the Brain-Early Illustrations of Cerebral Cortex and Its Gyri. Pediatr Neurol, 2017. 75: p. 6-10.
2. Ackerman, M.J., The Visible Human Project: a resource for education. Acad Med, 1999. 74(6): p. 667-70.
3. Abe, M., et al., Model-based surgical planning and simulation of cranial base surgery. Neurol Med Chir (Tokyo), 1998. 38(11): p. 746-50; discussion 750-1.
4. Ackerman, M.J., T. Yoo, and D. Jenkins, From data to knowledge--the Visible Human Project continues. Stud Health Technol Inform, 2001. 84(Pt 2): p. 887-90.
5. de Ribaupierre, S. and T.D. Wilson, Construction of a 3-D anatomical model for teaching temporal lobectomy. Comput Biol Med, 2012. 42(6): p. 692-6.
6. Shono, N., et al., Microsurgery Simulator of Cerebral Aneurysm Clipping with Interactive Cerebral Deformation Featuring a Virtual Arachnoid. Oper Neurosurg (Hagerstown), 2017.
7. Kimura, T., et al., Simulation of and training for cerebral aneurysm clipping with 3-dimensional models. Neurosurgery, 2009. 65(4): p. 719-25; discussion 725-6.
8. Bernardo, A., et al., A three-dimensional interactive virtual dissection model to simulate transpetrous surgical avenues. Neurosurgery, 2003. 52(3): p. 499-505; discussion 504-5.
9. Stredney, D., et al., Temporal bone dissection simulation--an update. Stud Health Technol Inform, 2002. 85: p. 507-13.
10. Kuppersmith, R.B., et al., Building a virtual reality temporal bone dissection simulator. Stud Health Technol Inform, 1997. 39: p. 180-6.
11. Anil, S.M., et al., Virtual 3-dimensional preoperative planning with the dextroscope for excision of a 4th ventricular ependymoma. Minim Invasive Neurosurg, 2007. 50(2): p. 65-70.
12. Kockro, R.A. and P.Y. Hwang, Virtual temporal bone: an interactive 3-dimensional learning aid for cranial base surgery. Neurosurgery, 2009. 64(5 Suppl 2): p. 216-29; discussion 229-30.
13. Zirkle, M.R., DW; Leuwer, R; Dubrowski, A, Using a virtual reality temporal bone simulator to assess otolaryngology trainees. Laryngoscope, 2007. 117(2): p. 258-63.
14. Zielinski, P. and P. Sloniewski, Virtual modelling of the surgical anatomy of the petrous bone. Folia Morphol (Warsz), 2001. 60(4): p. 343-6.
15. Wiet, G.J., et al., Virtual temporal bone dissection: an interactive surgical simulator. Otolaryngol Head Neck Surg, 2002. 127(1): p. 79-83.
16. Wang, H., et al., Three-dimensional virtual model of the human temporal bone: a stand-alone, downloadable teaching tool. Otol Neurotol, 2006. 27(4): p. 452-7.
17. Qiu, M.G., et al., Visualization of the temporal bone of the Chinese Visible Human. Surg Radiol Anat, 2004. 26(2): p. 149-52.
18. Nowinski, W.L., et al., Three-dimensional reference and stereotactic atlas of human cerebrovasculature from 7Tesla. Neuroimage, 2011. 55(3): p. 986-98.