Virtual Exploration of Safe Entry Zones in the Brainstem: Comprehensive Definition and Analysis of the Operative Approach

World Neurosurg. 2020 Aug:140:499-508. doi: 10.1016/j.wneu.2020.05.207. Epub 2020 May 29.


Background: A detailed and accurate understanding of the intrinsic brainstem anatomy and the interrelationship between its internal tracts and nuclei and external landmarks is of paramount importance for safe and effective brainstem surgery. Using anatomical models can be an important step in increasing such understanding. In the present study, we have shown the applicability of our developed virtual 3-dimensional (3D) model in depicting the safe entry zones (SEZs) to the brainstem.

Methods: Accurate 3D virtual models of brainstem elements were created using high-resolution magnetic resonance imaging and computed tomography to depict the brainstem SEZs.

Results: All the described SEZs to different parts of the brainstem were successfully depicted using our 3D virtual models.

Conclusions: The virtual models provide an immersive experience of brainstem anatomy, allowing users to understand the intricacies of the microdissection that is necessary to appropriately work through the brainstem nuclei and tracts toward a particular target. The models provide an unparalleled learning environment to understand the SEZs into the brainstem that can be used for training and research.

Keywords: 3D; Brainstem surgery; Medulla oblongata; Microdissection; Operative anatomy; Safe entry zone; Virtual model.

MeSH terms

  • Brain Stem / anatomy & histology
  • Brain Stem / diagnostic imaging
  • Brain Stem / surgery*
  • Cerebral Angiography
  • Humans
  • Imaging, Three-Dimensional
  • Magnetic Resonance Imaging
  • Microsurgery / methods
  • Models, Anatomic*
  • Neurosurgical Procedures / methods*
  • Tomography, X-Ray Computed
  • Virtual Reality*