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J Neurol Surg B Skull Base 2022; 83(S 02): e298-e305
DOI: 10.1055/s-0041-1729975
Original Article

Operative Anatomy of the Skull Base: 3D Exploration with a Highly Detailed Interactive Atlas

Ralf A. Kockro
1   Department of Neurosurgery, Hirslanden Hospital, Zürich, Switzerland
2   Department of Neurosurgery, University of Mainz, Mainz, Germany
,
Eike Schwandt
2   Department of Neurosurgery, University of Mainz, Mainz, Germany
,
Florian Ringel
2   Department of Neurosurgery, University of Mainz, Mainz, Germany
,
Christian Valentin Eisenring 
1   Department of Neurosurgery, Hirslanden Hospital, Zürich, Switzerland
,
Wieslaw Lucjan Nowinski
3   John Paul II Center for Virtual Anatomy and Surgical Simulation, University of Cardinal Stefan Wyszynski, Warsaw, Poland
› Author Affiliations Funding None.
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Abstract

Objective We evaluated the usefulness of a three-dimensional (3D) interactive atlas to illustrate and teach surgical skull base anatomy in a clinical setting.

Study Design A highly detailed atlas of the adult human skull base was created from multiple high-resolution magnetic resonance imaging (MRI) and computed tomography (CT) scans of a healthy Caucasian male. It includes the parcellated and labeled bony skull base, intra- and extracranial vasculature, cranial nerves, cerebrum, cerebellum, and brainstem. We are reporting retrospectively on our experiences with employing the atlas for the simulation and teaching of neurosurgical approaches and concepts in a clinical setting.

Setting The study was conducted at the University Hospital Mainz, Germany, and Hirslanden Hospital, Zürich, Switzerland.

Participants Medical students and neurosurgical residents participated in this study.

Results Handling the layered graphical user interface of the atlas requires some training; however, navigating the detailed 3D content from intraoperative perspectives led to quick comprehension of anatomical relationships that are otherwise difficult to perceive. Students and residents appreciated the collaborative learning effect when working with the atlas on large projected screens and markedly improved their anatomical knowledge after interacting with the software.

Conclusion The skull base atlas provides an effective way to study essential surgical anatomy and to teach operative strategies in this complex region. Interactive 3D computer graphical environments are highly suitable for conveying complex anatomy and to train and review surgical concepts. They remain underutilized in clinical practice.

Keywords

interactive 3D brain atlas - operative anatomy - human skull base - neurosurgery training

Informed Consent

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.


Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


Ethics

The manuscript does not contain clinical studies or patient data.




Publication History

Received: 10 August 2020

Accepted: 24 February 2021

Article published online:
03 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Michaels L, Soucek S, Liang J. The ear in the acquired immunodeficiency syndrome: I. Temporal bone histopathologic study. Am J Otol 1994; 15 (04) 515-522
    PubMedGoogle Scholar
  • 2 de Faria JWV, Teixeira MJ, de Moura Sousa Júnior L, Otoch JP, Figueiredo EG. Virtual and stereoscopic anatomy: when virtual reality meets medical education. J Neurosurg 2016; 125 (05) 1105-1111
    CrossrefPubMedGoogle Scholar
  • 3 Hendricks BK, Patel AJ, Hartman J, Seifert MF, Cohen-Gadol A. Operative anatomy of the human skull: a virtual reality expedition. Oper Neurosurg (Hagerstown) 2018; 15 (04) 368-377
    CrossrefPubMedGoogle Scholar
  • 4 Kuppersmith RB, Johnston R, Moreau D, Loftin RB, Jenkins H. Building a virtual reality temporal bone dissection simulator. Stud Health Technol Inform 1997; 39: 180-186
    PubMedGoogle Scholar
  • 5 Stredney D, Wiet GJ, Bryan J. et al. Temporal bone dissection simulation--an update. Stud Health Technol Inform 2002; 85: 507-513
    PubMedGoogle Scholar
  • 6 Hwang P, Kockro R, Lee C. Virtual reality simulation for skull base surgery. Asian J Neurosurg 2007; 1: 1-8
    PubMedGoogle Scholar
  • 7 Bernardo A, Preul MC, Zabramski JM, Spetzler RF. A three-dimensional interactive virtual dissection model to simulate transpetrous surgical avenues. Neurosurgery 2003; 52 (03) 499-505 , discussion 504–505
    CrossrefPubMedGoogle Scholar
  • 8 de Notaris M, Prats-Galino A, Cavallo LM. et al. Preliminary experience with a new three-dimensional computer-based model for the study and the analysis of skull base approaches. Childs Nerv Syst 2010; 26 (05) 621-626
    CrossrefPubMedGoogle Scholar
  • 9 de Notaris M, Palma K, Serra L. et al. A three-dimensional computer-based perspective of the skull base. World Neurosurg 2014; 82 (6, Suppl): S41-S48
    CrossrefPubMedGoogle Scholar
  • 10 Estevez ME, Lindgren KA, Bergethon PR. A novel three-dimensional tool for teaching human neuroanatomy. Anat Sci Educ 2010; 3 (06) 309-317
    CrossrefPubMedGoogle Scholar
  • 11 Höhne K-H. VOXEL-MAN 3D-Navigator: Brain and Skull: Regional, Functional, and Radiological Anatomy [CD-ROM]. Version 2.0. Heidelberg: Springer; 2001
    Google Scholar
  • 12 Kockro RA, Serra L, Tsai YT. et al. Planning of skull base surgery in the virtual workbench: clinical experiences. Stud Health Technol Inform 1999; 62: 187-188
    PubMedGoogle Scholar
  • 13 Kockro RA, Serra L, Tseng-Tsai Y. et al. Planning and simulation of neurosurgery in a virtual reality environment. Neurosurgery 2000; 46 (01) 118-135 , discussion 135–137
    CrossrefPubMedGoogle Scholar
  • 14 Kockro RA, Stadie A, Schwandt E. et al. A collaborative virtual reality environment for neurosurgical planning and training. Neurosurgery 2007; 61 (05, Suppl 2): discussion 391 379-391
    PubMedGoogle Scholar
  • 15 Kockro RA, Hwang PY. Virtual temporal bone: an interactive 3-dimensional learning aid for cranial base surgery. Neurosurgery 2009; 64 (05, Suppl 2): discussion 229–230 216-229
    PubMedGoogle Scholar
  • 16 Oishi M, Fukuda M, Yajima N. et al. Interactive presurgical simulation applying advanced 3D imaging and modeling techniques for skull base and deep tumors. J Neurosurg 2013; 119 (01) 94-105
    CrossrefPubMedGoogle Scholar
  • 17 Stadie AT, Kockro RA, Reisch R. et al. Virtual reality system for planning minimally invasive neurosurgery. Technical note. J Neurosurg 2008; 108 (02) 382-394
    CrossrefPubMedGoogle Scholar
  • 18 Nowinski W, Bryan R, Raghavan R. The Electronic Clinical Brain Atlas: Multiplanar Navigation of the Human Brain [CD-ROM]. New York, NY: Thieme; 1997
    Google Scholar
  • 19 Schaltenbrand G, Wahren W, Hassler RG. Atlas for Stereotaxy of the Human Brain. Stuttgart: Thieme; 1977
    Google Scholar
  • 20 Talairach J, Tournoux P. Co-planar Stereotaxic Atlas of the Human Brain: 3-Dimensional Proportional System: an Approach to Cerebral Imaging. Stuttgart-New York: Thieme; 1988
    Google Scholar
  • 21 Nowinski WL, Chua BC, Yang GL, Qian GY. Three-dimensional interactive and stereotactic human brain atlas of white matter tracts. Neuroinformatics 2012; 10 (01) 33-55
    CrossrefPubMedGoogle Scholar
  • 22 Nowinski WL, Johnson A, Chua BC, Nowinska NG. Three-dimensional interactive and stereotactic atlas of cranial nerves and nuclei correlated with surface neuroanatomy, vasculature and magnetic resonance imaging. J Neurosci Meth 2012; 206 (02) 205-216
    CrossrefPubMedGoogle Scholar
  • 23 Nowinski WL. 3D atlas of the brain, head and neck in 2953 pieces. Neuroinformatics 2017; 15 (04) 395-400
    CrossrefPubMedGoogle Scholar
  • 24 Nowinski WL, Thaung TSL. A 3D stereotactic atlas of the adult human skull base. Brain Inform 2018; 5 (02) 1
    CrossrefPubMedGoogle Scholar
  • 25 Federative Committee on Anatomical Terminology (FCAT). Terminologia Anatomica. Stuttgart: Georg Thieme Verlag; 1998
    Google Scholar
  • 26 Nowinski WLCB, Thaung TSL, Wut Yi SH. Human brain, head and neck in 2953 pieces. Available at: http://www.thieme.com/nowinski/
    PubMedGoogle Scholar
  • 27 Gray H, Standring S. Gray's Anatomy: The Anatomical Basis of Clinical Practice. London: Churchill Livingstone; 2008
    Google Scholar
  • 28 Lamperti ED, Ross LM, Schumacher U, Schulte E, Schuenke M. Comprar Head and Neuroanatomy (THIEME Atlas of Anatomy). | Edward D Lamperti. Head and Neuroanatomy (THIEME Atlas of Anatomy).. 2010
    Google Scholar
  • 29 Schuenke MSE, Schumacher U. Atlas of anatomy.. Head and neuroanatomy. Stuttgart-New York: Thieme; 2010
    Google Scholar
  • 30 Harnsberger H, Osborn A, MacDonald A. et al. Diagnostic and surgical imaging anatomy: brain, head & neck, spine. AJNR Am J Neuroradiol 2007; 28 (04) 795-796
    PubMedGoogle Scholar
  • 31 Hirsch MC, Kramer T. Neuroanatomy: 3D-Stereoscopic Atlas of the Human Brain. Berlin: Springer Science + Business Media; 2012
    Google Scholar
  • 32 Jackler RK, Gralapp C. Atlas of Skull Base Surgery and Neurotology. New York, NY: Thieme; 2009
    Google Scholar
  • 33 Janecka IP, Tiedemann K. Skull Base Surgery: Anatomy, Biology, and Technology. Philadelphia, PA: Lippincott-Raven; 1997
    Google Scholar
  • 34 Lang J. Skull Base and Related Structures: Atlas of Clinical Anatomy. Stuttgart: Schattauer Verlag; 2001
    Google Scholar
  • 35 Wanibuchi M, Friedman AH, Fukushima T. Photo Atlas of Skull Base Dissection: Techniques and Operative Approaches. New York, NY: Thieme; 2009
    Article in Thieme ConnectGoogle Scholar
  • 36 Fliss DM, Gil Z. Atlas of Surgical Approaches to Paranasal Sinuses and the Skull Base. Berlin: Springer; 2016
    CrossrefGoogle Scholar
  • 37 Rhoton Jr AL. Jugular foramen. Neurosurgery 2000; 47 (3, Suppl): S267-S285
    CrossrefPubMedGoogle Scholar
  • 38 Rhoton Jr AL. The foramen magnum. Neurosurgery 2000; 47 (3, Suppl): S155-S193
    PubMedGoogle Scholar
  • 39 Rhoton Jr AL. The orbit. Neurosurgery 2002; 51 (4, Suppl): S303-S334
    PubMedGoogle Scholar
  • 40 Rhoton Jr AL. The anterior and middle cranial base. Neurosurgery 2002; 51 (4, Suppl): S273-S302
    PubMedGoogle Scholar
  • 41 Rhoton Jr AL. The sellar region. Neurosurgery 2002; 51 (4, Suppl): S335-S374
    PubMedGoogle Scholar
  • 42 Rhoton Jr AL. Rhoton Cranial Anatomy and Surgical Approaches. Philadelphia, PA: Lippincott Williams & Wilkins; 2003
    Google Scholar
  • 43 Rhoton Jr Al. The temporal bone and transtemporal approaches. Neurosurgery 2000; 47 (3 Suppl): S211-65
    CrossrefPubMedGoogle Scholar
  • 44 Stoker NG, Mankovich NJ, Valentino D. Stereolithographic models for surgical planning: preliminary report. J Oral Maxillofac Surg 1992; 50 (05) 466-471
    CrossrefPubMedGoogle Scholar
  • 45 Ackerman MJ. The Visible Human Project: a resource for education. Acad Med 1999; 74 (06) 667-670
    CrossrefPubMedGoogle Scholar
  • 46 Ackerman MJ, Yoo T, Jenkins D. From data to knowledge--the visible human project continues. Stud Health Technol Inform 2000; 84 (Pt 2): 887-890
    PubMedGoogle Scholar
  • 47 Berkovitz B. Interactive Head and Neck [CD]. London: Primal Pictures Limited; 2003
    Google Scholar
  • 48 Jakab M, Kikinis R. Head and Neck Atlas. Boston, MA: Surgical Planning Laboratory Harvard Medical School; 2015
    Google Scholar
  • 49 Visible Body®. Human Anatomy Atlas 2019: Complete 3D Human Body. Boston, MA: Visible Body; 2019
    PubMedGoogle Scholar
  • 50 Kimura T, Morita A, Nishimura K. et al. Simulation of and training for cerebral aneurysm clipping with 3-dimensional models. Neurosurgery 2009; 65 (04) 719-725 , discussion 725–726
    CrossrefPubMedGoogle Scholar
  • 51 Shono N, Kin T, Nomura S. et al. Microsurgery simulator of cerebral aneurysm clipping with interactive cerebral deformation featuring a virtual arachnoid. Oper Neurosurg (Hagerstown) 2018; 14 (05) 579-589
    CrossrefPubMedGoogle Scholar
  • 52 Heiland M, Von Sternberg-Gospos N, Pflesser B. et al. Virtual simulation of dental surgery using a three-dimensional computer model with a force feedback system [in German]. Mund Kiefer Gesichtschir 2004; 8 (03) 163-166
    PubMedGoogle Scholar
  • 53 Kockro RA, Killeen T, Ayyad A. et al. Aneurysm surgery with preoperative three-dimensional planning in a virtual reality environment: technique and outcome analysis. World Neurosurg 2016; 96: 489-499
    CrossrefPubMedGoogle Scholar
  • 54 Johnson A, Leigh J, Morin P, Van Keken P. GeoWall: stereoscopic visualization for geoscience research and education. IEEE Comput Graph Appl 2006; 26 (06) 10-14
    CrossrefPubMedGoogle Scholar
  • 55 Kockro RA, Amaxopoulou C, Killeen T. et al. Stereoscopic neuroanatomy lectures using a three-dimensional virtual reality environment. Ann Anat 2015; 201: 91-98
    CrossrefPubMedGoogle Scholar
  • 56 Berney S, Bétrancourt M, Molinari G, Hoyek N. How spatial abilities and dynamic visualizations interplay when learning functional anatomy with 3D anatomical models. Anat Sci Educ 2015; 8 (05) 452-462
    CrossrefPubMedGoogle Scholar
  • 57 Kirkman MA, Muirhead W, Nandi D, Sevdalis N. Development and psychometric evaluation of the “Neurosurgical Evaluation of Attitudes towards simulation Training” (NEAT) tool for use in neurosurgical education and training. World Neurosurg 2014; 82 (3–4): 284-291
    CrossrefPubMedGoogle Scholar
  • 58 Yammine K, Violato C. A meta-analysis of the educational effectiveness of three-dimensional visualization technologies in teaching anatomy. Anat Sci Educ 2015; 8 (06) 525-538
    CrossrefPubMedGoogle Scholar