title: A three-dimensional computer-based perspective of the skull base.
abstract: OBJECTIVE
  To describe our designed protocol for the reconstruction of three-dimensional (3D) models applied to various endoscopic endonasal approaches that allows performing a 3D virtual dissection of the desired approach and analyzing and quantifying critical surgical landmarks.
  
  
  METHODS
  All human cadaveric heads were dissected at the Laboratory of Surgical Neuroanatomy of the University of Barcelona. The dissection anatomic protocol was designed as follows: 1) virtual surgery simulation systems, 2) navigated cadaver dissection, and 3) postdissection analysis and quantification of data.
  
  
  RESULTS
  The virtual dissection of the selected approach, the preliminary exploration of each specimen, the real dissection laboratory experience, and the analysis of data retrieved during the dissection step provide a complete method to improve general knowledge of the main endoscopic endonasal approaches to the skull base, at the same time allowing the development of new surgical techniques.
  
  
  CONCLUSIONS
  The methodology for surgical training in the anatomic laboratory described in this article has proven to be very effective, producing a depiction of anatomic landmarks as well as 3D visual feedback that improves the study, design, and execution in various neurosurgical approaches. The Dextroscope as a virtual surgery simulation system can be used as a preoperative planning tool that can allow the neurosurgeon to perceive, practice reasoning, and manipulate 3D representations using the transsphenoidal perspective acquiring specifically visual information for endoscopic endonasal approaches to the skull base. The Dextroscope also can be used as an advanced tool for analytic purposes to perform different types of measurements between surgical landmarks before, during, and after dissection.
authors.affiliation: Department of Neurosurgery, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain; Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain. Electronic address: matteodenotaris@gmail.com.
authors.forename: Matteo
authors.initials: M
authors.lastname: de Notaris
authors.affiliation: Department of Neurosurgery, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Palma
authors.affiliation: Center for Computational Imaging and Simulation Technologies in Biomedicine, Information and Communication Technologies Department, Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Serra
authors.affiliation: Department of Neurosurgery, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Enseñat
authors.affiliation: Department of Otorhinolaryngology, Rhinology Unit, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Isam
authors.initials: I
authors.lastname: Alobid
authors.affiliation: Department of Neurosurgery, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Poblete
authors.affiliation: Department of Radiology, Neuroradiology Division, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Joan Berenguer
authors.initials: JB
authors.lastname: Gonzalez
authors.affiliation: Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Solari
authors.affiliation: Department of Neurosurgery, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Ferrer
authors.affiliation: Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Prats-Galino
mesh_terms: D002102:Cadaver; D004210:Dissection; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000601:surgery; D019990:Perioperative Care; D019291:Skull Base / Q000033:anatomy & histology* / Q000601:surgery; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed
keywords: 3D computer model; Dextroscope; Endoscopic endonasal surgery; Skull base; Surgical anatomy