3D Simulation (Dextroscope) for Virtual Reality Surgical Planning of Skull Base and Vascular Surgery

Background: Large skull base tumors require good preoperative planning to maximize resection. Preoperative assessment of the orientation of the aneurysm and its relationship to the proximal and distal branches is important for successful clipping.

Objective: To report our early experience with 3D virtual reality simulation (Dextroscope) of intracranial aneurysm clipping and surgical resection of skull base lesions.

Methods: From April 2007 to October 2008, patient-specific digital imaging of CT angiography scans with or without MRI were transferred to the workstation (Dextroscope) for 3D virtual reality visualization of the configuration of 9 cases of intracranial aneurysms (8 involving the middle cerebral artery and 1 involving the anterior communication artery) and 12 cases of skull base lesions.

Results: After a short period of training and practice, the system proved easy to operate and is currently used for preoperative planning of difficult cases at the senior author's institute. The Dextroscope converts the 2D projections of the 3D CT angiographic and MRI data into a 3D virtual reality simulation, allowing spatial orientation, depth perception, and 3D configuration of the aneurysms and skull base lesions in relation to parent vessel, branches, and brain. The obtained 3D virtual reality images of the aneurysms and skull base lesions were similar to those obtained with the intraoperative binocular microscopic views. This results in an intraoperative sense of déjà vu, facilitating successful clipping.

Conclusion: The 3D virtual reality modes allow easy visualization of spatial orientation, depth perception, and 3D configuration of intracranial aneurysms. The use of such technology in neurosurgical training is stimulating and educational and should be extended to all other complex intracranial pathology as an adjunct to surgical dissection.