Foundations of Advanced Neuroanatomy: Technical Guidelines for Specimen Preparation, Dissection, and Three-Dimensional Photodocumentation in a Surgical Anatomy Laboratory

Introduction: Professor Albert L. Rhoton Jr., MD, was a pioneer in neurosurgical anatomy study, and his methodology regarding dissections and photodocumentation remains a standard and reference in surgical anatomy research. The objective of this work is to provide a key update to the seminal methodology works of Professor Albert L. Rhoton Jr, MD, with particular attention to previously unpublished insights from the oral tradition of his fellows, recent technological advances including endoscopy and high dynamic range (HDR) photodocumentation, and local improvements in technique, we have developed to optimize efficient neuroanatomic study.

Materials and Methods: Ten formaldehyde-fixed cadaveric heads were injected with colored latex to demonstrate step-by-step specimen preparation for microscopic or endoscopic dissection. One formaldehyde-fixed brain was utilized to demonstrate optimal 3D photodocumentation techniques.

Results: Key steps of specimen preparation include vessel cannulation and securing of carotid arteries, vertebral arteries, internal jugular veins, serial tap water flushing, specimen drainage, vessel injection with optimized and color-augmented latex material, and storage in 70% ethanol (Fig. 1). Optimizations for photodocumentation included the incorporation of dry black drop cloth and covering materials, an imaging-oriented approach to specimen positioning and illumination, and single-camera stereoscopic capture techniques, emphasizing the 3 exposure times per eye approach to generating images for HDR postprocessing (Figs. 2–4). Recommended tools, materials, and technical nuances were emphasized throughout. Relative advantages and limitations of major 3D projection systems were comparatively assessed, with sensitivity to audience size and purpose specific recommendations.

Conclusion: We describe the first consolidated, step-by-step approach to advanced neuroanatomy, including specimen preparation, dissection, and 3D photodocumentation, supplemented by previously unpublished insights from the Rhoton fellowship experience and lessons learned in our laboratories in the past years such that Professor Rhoton’s model can be realized, reproduced, and expanded upon in surgical neuroanatomy laboratories worldwide.