Virtual Reality Model of the Three-Dimensional Anatomy of the Cavernous Sinus Based on a Cadaveric Image and Dissection

The Course of the Trochlear Nerve Presented via a 3-Dimensional Photorealistic Anatomic Model

OBJECTIVES

Several factors contribute to the anatomical complexity of the trochlear nerve, including small diameter, complex and longest intracranial course, deep location, and numerous neurovascular relationships. A 3-dimensional (3D) photorealistic model of the cranial nerves provides a detailed and immersive representation of the anatomy, enabling one to improve surgical planning, advanced surgical research, and training. The purpose of this work is to present a 3D photogrammetric study for a more intuitive and interactive way to explore and describe the entire course of trochlear nerve.

METHODS

Two injected-fixed head human specimens (4 sides) were examined. The dissection protocol was divided into the following steps: 1) brain hemisphere exposure; 2) hemispherectomy dissecting all cranial nerves and partial removal of the free edge of the tentorium; 3) middle fossa and lateral wall of cavernous sinus exposure; and 4) orbital exposure. A detailed 3D photogrammetric model was generated for each dissection step.

RESULTS

Four main volumetric models were generated during a step-by-step layered dissection of the entire nerve pathway highlighting its different segments. Finally, a full and integrated model of the entire course of the nerve was created. The models are available for visualization on monoscopic display, virtual, and augmented reality environment.

CONCLUSIONS

The present photogrammetric model provides a more comprehensive understanding of the nerve's anatomy in its different segments, allows for customizable views thus simulating different perspectives, and can be a valuable alternative to traditional dissections. It is an advanced tool for surgical planning and surgical simulation as well as virtual reality representation of the anatomy.

Conservation of pyramidal tract in radiosurgery for brain metastases of lung adenocarcinoma: Three-dimensional analysis of biologically effective dose

BACKGROUND

Gamma knife surgery (GKS) for brain metastases (BMs) adjacent to the pyramidal tract (PT) is still a challenge to conduct. PT visualization and biologically effective dose (BED) calculation on a voxel-by-voxel basis may provide data to establish clinically safe values. We aimed to assess the relationship of parameters extracted from the BED-volume histogram with outcomes of PT after GKS-treating target (adjacent BM of lung adenocarcinoma).

METHODS

We formed BED-volume histograms for 672 BMs in a retrospective cohort, using 3-dimensional (3D) coordinate values of PT, target, and each iso-centre to calculate the 3D BED distribution in a 200 × 200 × 200 matrix. PT conservation failure (PTCF) was judged clinically and radiologically and classified as lesion progression and radionecrosis. Cox proportional hazards models were used to analyse 3D BED parameters. Internal validation of models was performed by bootstrapping.

RESULTS

There were 116 (17.3 %) subjects with PTCF in the cohort, of which 74 (11.0 %) and 42 (6.3 %) were caused by lesion progression and radionecrosis, respectively. Multivariate analysis showed that D_{Lesion_min} BED and D_{Lesion_90%} BED significantly predicted lesion progression (P <.001). D_{PT_Max} BED and V_{PT_ BED40} significantly predicted radionecrosis (P <.001). The model predicting PTCF showed fair discrimination and calibration of D_{Lesion_min} BED + D_{Lesion_90%} BED and D_{PT_Max} BED + V_{PT_ BED40}.

CONCLUSIONS

The conservation of PT in GKS for BMs of lung adenocarcinoma depends on the combination of PT-tolerated BED and target effective control BED. Therefore, a BED-volume histogram with a 3D BED algorithm is proposed to assess plan quality.

A data-centric artificial intelligent and extended reality technology in smart healthcare systems

Extended reality (XR) solutions are quietly maturing, and their novel use cases are already being investigated, particularly in the healthcare industry. By 2022, the extended reality market is anticipated to be worth $209 billion. Certain diseases, such as Alzheimer's, Schizophrenia, Stroke rehabilitation stimulating specific areas of the patient's brain, healing brain injuries, surgeon training, realistic 3D visualization, touch-free interfaces, and teaching social skills to children with autism, have shown promising results with XR-assisted treatments. Similar effects have been used in video game therapies like Akili Interactive's EndeavorRx, which has previously been approved by the Food and Drug Administration (FDA) as a treatment regimen for children with attention deficit hyperactivity disorder (ADHD). However, while these improvements have received positive feedback, the field of XR-assisted patient treatment is in its infancy. The growth of XR in the healthcare sphere has the potential to transform the delivery of medical services. Imagine an elderly patient in a remote setting having a consultation with a world-renowned expert without ever having to leave their house. Rather than operating on cadavers in a medical facility, a surgical resident does surgery in a virtual setting at home. On the first try, a nurse uses a vein finder to implant an IV. Through cognitive treatment in a virtual world, a war veteran recovers from post-traumatic stress disorder (PTSD). The paper discusses the potential impact of XR in transforming the healthcare industry, as well as its use cases, challenges, XR tools and techniques for intelligent health care, recent developments of XR in intelligent healthcare services, and the potential benefits and future aspects of XR techniques in the medical domain.

Toward a model for assessing smart hospital readiness within the Industry 4.0 paradigm

Purpose

The fourth industrial revolution and digital transformation have caused paradigm changes in the procedures of goods production and services through disruptive technologies, and they have formed new methods for business models. Health and medicine fields have been under the effect of these technology advancements. The concept of smart hospital is formed according to these technological transformations. The aim of this research, other than explanation of smart hospital components, is to present a model for evaluating a hospital readiness for becoming a smart hospital.

Design/methodology/approach

This research is an applied one, and has been carried out in three phases and according to design science research. Based on the previous studies, in the first phase, the components and technologies effecting a smart hospital are recognized. In the second phase, the extracted components are prioritized using type-2 fuzzy analytic hierarchical process based on the opinion of experts; later, the readiness model is designed. In the third phase, the presented model would be tested in a hospital.

Findings

The research results showed that the technologies of internet of things, robotics, artificial intelligence, radio-frequency identification as well as augmented and virtual reality had the most prominence in a smart hospital.

Originality/value

The innovation and originality of the forthcoming research is to explain the concept of smart hospital, to rank its components and to provide a model for evaluating the readiness of smart hospital. Contribution of this research in terms of theory explains the concept of smart hospital and in terms of application presents a model for assessing the readiness of smart hospitals.

Volumetric comparative analysis of anatomy through far-lateral approach: surgical space and exposed tissues

Background

The three-dimensional (3D) visualization model has ability to quantify the surgical anatomy of far-lateral approach. This study was designed to disclose the relationship between surgical space and exposed tissues in the far-lateral approach by the volumetric analysis of 3D model.

Methods

The 3D skull base models were constructed using MRI and CT data of 15 patients (30 sides) with trigeminal neuralgia. Surgical corridors of the far-lateral approach were simulated by triangular pyramids to represent two surgical spaces exposing bony and neurovascular tissues. Volumetric comparison of surgical anatomy was performed using pair t test.

Results

The morphometric results were almost the same in the two surgical spaces except the vagus nerve (CN X) exposed only in one corridor, whereas the volumetric comparison represented the statistical significant differences of surgical space and bony and neurovascular tissues involved in the two corridors (P<0.001). The differences of bony and neurovascular tissues failed to equal the difference of surgical space.

Conclusions

For far-lateral approach, the increase of exposure for the bony and neurovascular tissues is not necessarily matched with the increase of surgical space. The volumetric comparative analysis is helpful to provide more detailed anatomical information in the surgical design.

Development of a Cadaveric Multiport Model of Posterior Circulation Aneurysm Clipping for Neurosurgery and Otolaryngology Residents

Posterior circulation aneurysms are difficult to treat with the current methods of coiling and clipping. To address limitations in training, we developed a cadaveric model to train learners on endoscopic clipping of posterior circulation aneurysms. An endoscopic transclival approach (ETA) and a transorbital precaruncular approach (TOPA) to successfully access and clip aneurysms of the posterior circulation are described. The model has flexibility in that a colored silicone compound can be injected into the cadaveric vessels for the purpose of training learners on vascular anatomy. The other option is that the model could be connected to a vascular perfusion pump allowing real-time appreciation of a pulsatile or ruptured aneurysm. This cadaveric model is the first of its kind for training of endoscopic clipping of posterior circulation aneurysms. Learners will develop proficiency in endoscopic skills, appropriate dissection, and appreciation for relative anatomy while developing an algorithm that can be employed in a real operative arena. Going forward, various clinical scenarios can be developed to enhance the realism, allow learners from different specialties to work together, and emphasize the importance of teamwork and effective communication.

Scoping Zygomaticomaxillary Complex Fractures With the Eyes of Virtual Reality: Operative Protocol and Proposal of a Modernized Classification

INTRODUCTION

Fractures of the zygomaticomaxillary complex (ZMC) represent an extremely heterogeneous group of injuries to the midfacial skeleton. Traditionally, the diagnosis of such fractures was based on 2-dimensional radiograms and, more recently, on volumetric computed tomography (CT) scans, while the treatment was exclusively based on the surgeon's experience. Many classification attempts have been made in the past, but no paper has taken into account the importance of virtual surgical planning (VSP) in proving a modernized classification. The authors propose a classification based on the use of VSP which can guide the surgeon to identify the optimal reduction method and reproduce it in the operating room through the use of navigation.

METHODS

Patients with ZMC fractures were collected to create a study model. The VSP was used to generate 3-dimensional models of fractures. Fractured segments were duplicated and digitally put in the optimal reduction position. Repositioned fragments were overlapped to their original preoperative counterparts and exported to the surgical navigator to be navigated. Planned virtual reduction was overlaid to postoperative CT scan to assess the accuracy of reduction, explored using color maps and the calculation of root mean square error.

RESULTS

For all patients, the application of VSP was successfully accomplished. High accuracy was confirmed between the planned virtual reduction and the postoperative CT scan. A 5-item classification based on VSP is proposed. All patients were included in the presented subclasses.

CONCLUSIONS

The adoption of virtual planning in ZMC fractures allows for an improved study of the displacement of the fracture and might indicate to the surgeons the required maneuvers to achieve optimal reduction. The presented proposal of classification might be an aid to simplify the choice of the most appropriate reduction method and might provide a deeper insight into the morphologic characteristics of fractures.

Quantification of Microsurgical Anatomy in Three-Dimensional Model: Transfrontal Approach for Anterior Portion of the Thalamus

The thalamus located in the deep site of cerebrum with the risk of internal capsule injury during operation. The purpose of this study was to compare the anatomy for exposure and injury using simulative surgical corridor of 3-dimensional model. The 3-dimensional anatomy model of thalamus in cerebrum was created based on magnetic resonance imaging performed for 15 patients with trigeminal neuralgia. The midpoint of line between anterior edge and top of thalamus was the target exposed. Axis connecting the target with the anterior edge and top of caudate head was used to outline the cylinder, respectively, simulating surgical corridors 1 and 2 of transfrontal approach. Cerebral tissues involved in the corridors were observed, measured, and compared. Incision of cortex was made on the anterior portion of inferior frontal gyrus through corridor 1 and middle frontal gyrus through corridor 2. Both of the 2 corridors passed the caudate nucleus, the anterior limb and genu of internal capsule, ultimately reached the upper anterior portion of thalamus. The volumes of white matter, caudate head, and thalamus in the corridor 1 were more than those in corridor 2. Conversely, the volumes of cortex, internal capsule in corridor 2 were more than those in corridor 1. In conclusion, surgical anatomy-specific volume is helpful to postulate the intraoperative injury of transfrontal approach exposing anterior portion of the thalamus. The detailed information in the quantification of microsurgical anatomy will be used to develop minimally invasive operation.

Gridding Microsurgical Anatomy of Far Lateral Approach in the Three-Dimensional Model

OBJECTIVE

The far lateral craniotomy involves osteotomy of various portions of occipital condyle. Intracranial operation exposing clivus encounters complicated neurovascular anatomy. The aim of the present study was to make refinement for the anatomy of far lateral approach by gridding route in the 3-dimensional model.

METHODS

Computed tomography and magnetic resonance imaging data were used to construct 3-dimensional model containing osseous and neurovascular structures of skull base. Then, far lateral approach was simulated by triangular prism and divided into gridding surgical route. The relationship of surgical route and osseous and neurovascular structures was observed. Measurement of volume was performed to evaluate surgical exposure.

RESULTS

Observation of 3-dimensional model showed bony drilling of far lateral approach started with the occipital condyle and passed through the lateral edge of foramen magnum. The cerebellum and medulla oblongata were exempted from the surgical route exposing clivus. The anatomy variances of operative space, osseous, and neurovascular structures in the gridding route were displayed clearly and compared objectively.

CONCLUSION

The gridding operative spaces for the far lateral approach are useful to disclose the detailed discrepancy in the different surgical region. The volumetric measurement provides quantified information to facilitate a better understanding of the anatomy variance.