New stereoscopic virtual reality system application to cranial nerve microvascular decompression.
OBJECTIVE
Cranial nerve microvascular decompression is a habitual neurosurgical procedure. Authors describe a new application of the Dextroscope (Volume Interactions, Ltd.), a virtual reality environment, to plan and properly simulate this kind of procedures.


METHODS
In three cases of hemifacial spasm refractory to drugs and botulinum toxin treatment, the authors used a virtual reality workstation (Dextroscope) to develop an interactive simulation of craniotomy, approach, and Gore-Tex implant optimal size and position in order to reach vascular decompression of facial nerve.


RESULTS
Three-dimensional interactive environment allowed the authors to virtually carry out craniotomy, to visualize vascular and nerve relationship, and finally, to select and to simulate best Gore-Tex graft positioning in each case. During surgical procedures, facial nerve vascular compressions were exposed and Gore-Tex grafts were successfully placed as it was virtually planned. Patient outcomes were excellent, with an average improvement of two units (0-4 grades of severity scale).


CONCLUSIONS
Virtual reality environment can help the neurosurgeon to plan and train vascular decompression procedures. Use of appropriate craniotomy, knowledge of vascular and nerve relationship, and selection of optimum paddy size and position are the main useful applications of the Dextroscope in these procedures.
González Sánchez
Jose J
JJ
Department of Neurosurgery, Hospital Clinic of Barcelona, Barcelona, Spain. jjgcmb@hotmail.com
Enseñat Nora
Joaquin
J
Candela Canto
Santiago
S
Rumià Arboix
Jordi
J
Caral Pons
Luís A
LA
Oliver
David
D
Ferrer Rodríguez
Enrique
E
D001488:Basilar Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D017076:Computer-Aided Design / Q000295:instrumentation; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods*; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods*; D005154:Facial Nerve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D019569:Hemifacial Spasm / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D055806:Microvessels / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D038361:Neuronavigation / Q000295:instrumentation / Q000379:methods*; D011300:Preoperative Care / Q000295:instrumentation / Q000379:methods; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D014584:User-Computer Interface; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*