Development of a virtual dissection environment integrated into cadaveric dissection for skull base anatomy education.

Abstract

Objective: The authors sought to develop and integrate a novel virtual dissection (VD) environment using high-fidelity microanatomical 3D computer graphics (HFM-3DCG) with cadaveric dissection (CD) to enhance the anatomical understanding, procedural confidence, and overall satisfaction among neurosurgical residents for skull base approaches.

Methods: HFM-3DCG, designed to replicate complex skull base structures such as vessels, nerves, dura mater, and ligaments with high fidelity, was used to construct a VD environment including three skull base approaches: Dolenc, anterior petrosal, and presigmoid. The VD models enabled interactive visualization of the anatomical structures and real-time procedural simulations. Six neurosurgical residents performed all three approaches using VD integrated into the CD workflow. VD was used for confirming the anatomical landmarks in real time. Each approach included a stepwise progression from craniotomy to intradural exposure, with a maximum time limit of 150 minutes. After completing the procedures, participants evaluated the integrated learning environment using satisfaction and confidence questionnaires. Supervisors conducted objective assessments focusing on the residents' ability to accurately identify anatomical landmarks, comprehend spatial relationships, and execute procedures.

Results: A novel VD environment was developed using HFM-3DCG and integrated with CD to create a comprehensive anatomical learning environment. VD allowed learners to simulate key surgical techniques, such as drilling and brain retraction, thus enhancing procedural understanding. The integrated environment demonstrated high functionality, enabling residents to enhance their learning experience during CD. Satisfaction ratings were the highest for VD's visual accuracy, ease of integration with CD, and usefulness in skull base approaches. The confidence ratings indicated improvements in understanding 3D anatomical relationships, identifying critical structures, and performing procedures. Objective evaluations revealed an enhanced understanding of the 3D relationships between the anatomical structures. The median VD usage time was less than 20 minutes per approach, demonstrating the efficiency of CD augmentation without significant time extensions.

Conclusions: The new VD environment using HFM-3DCG provided high-fidelity and interactive anatomical visualization, enabling enhanced learning experiences. This study demonstrated the feasibility and benefits of integrating VD with CD for skull base surgical training. Procedural simulations, including drilling and brain retraction, offer realistic practical opportunities, further enriching anatomical understanding. This integrated environment can improve performance in actual surgeries by fostering a deeper comprehension of complex anatomical structures and procedures, offering a significant potential for advancing neurosurgical education and optimizing anatomical training.