Introduction of a New Interactive Paradigm to Define the Next Generation of Visualization in Neurosurgical Anatomy

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 2-dimensional (2D) schematics of the ventricular system surrounded by disorganized neural tissue.1 Increasingly 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 is a recent development but has an established presence in the neurosurgical literature. It began in the late 1980s and has evolved with the development of computer graphics.2,3 The next 3D modeling 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 modeling in neurosurgery has involved surgical planning for temporal lobectomy,5 cerebral aneurysm clipping,6,7 transpetrous surgical approach,8 temporal bone dissection,9,10 and posterior fossa surgical planning.11 Educational models that have been created include an interactive 3D virtual model of the temporal bone 12–17 and 3D cerebrovascular atlas.18 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 Operative Neurosurgery will introduce interactive 3D models that provide an immersive third dimension of both normal and pathological neurosurgical anatomy via virtual reality (VR) technology; these objects can also be manipulated within space on a 2D monitor (please see the instructions in Model 1). These models are the result of 5 yr of intense computerized sculpting work by The Neurosurgical Atlas team to create exceptionally detailed interactive virtual specimens that hopefully will provide an unparalleled realism of superficial and deep structures (Model 1). Model 1 Temporal bone and Deep StructuresThe instructions for use of this and the other following models are as follows: Please use the full screen function for optimal visualization (by clicking on the arrows on the right lower corner of the model). To move the model in 3D space, use your mouse0027s left click and drag; to enlarge the object, use the mouse0027s wheel. The right click and drag function moves the model across the plane. (Please note that you have to zoom in to see the inner ear structures. Alternatively, please click on the “Select an annotation” link at the bottom of the window and “show annotations” so that the anatomical labels become visible.) With permission from The Neurosurgical Atlas by Aaron Cohen-Gadol, MD. The neurosurgical operating room has also been created in this virtual environment and will be presented in the near future as an interactive VR 3D model (Figure 1). We sincerely hope that the viewers will find this new interactive multidimensional environment helpful in their understanding of cranial anatomy and operative neurosurgery for educational, illustrative, and surgical training purposes.Figure 1.: A, A picture of the operating room that has been constructed using computerized graphics modeling is shown. B and C, This work allows realism in presenting the patient and underlying structures. With permission from The Neurosurgical Atlas by Aaron Cohen-Gadol, MD.Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.