1
|
Marino S, Dannhoff G, Destrieux C, Maldonado IL. Frontal trans opercular approaches to the insula: building the mental picture from procedure-guided anatomical dissection. Surg Radiol Anat 2024; 46:1331-1344. [PMID: 38871860 DOI: 10.1007/s00276-024-03409-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Performing transopercular frontal approaches to the insula, widely used in glioma surgeries, necessitates a meticulous understanding of both cortical and subcortical neuroanatomy. This precision is vital for preserving essential structures and accurately interpreting the results of direct electrical stimulation. Nevertheless, acquiring a compelling mental image of the anatomy of this region can be challenging due to several factors, among which stand out its complexity and the fact that white matter fasciculi are imperceptible to the naked eye in the living brain. AIM In an effort to optimize the study of the anatomy relevant to this topic, we performed a procedure-guided laboratory study using subpial dissection, fiber dissection, vascular coloration, and stereoscopic photography in a "real-life" surgical perspective. METHODS Nine cerebral specimens obtained from body donation were extracted and fixed in formalin. Colored silicone injection and a variant of Klinglers's technique were used to demonstrate vascular and white matter structures, respectively. We dissected and photographed the specimens in a supero-antero-lateral view to reproduce the surgeon's viewpoint. The anatomy related to the development of the surgical corridor and resection cavity was documented using both standard photography and the red-cyan anaglyph technique. RESULTS The anatomy of frontal transopercular approaches to the insula involved elements of different natures-leptomeningeal, cortical, vascular, and fascicular-combining in the surgical field in a complex disposition. The disposition of these structures was successfully demonstrated through the aforementioned anatomical techniques. Among the main structures in or around the surgical corridor, the orbital, triangular, and opercular portions of the inferior frontal gyrus are critical landmarks in the cortical stage, as well as the leptomeninges of the Sylvian fissure and the M2-M4 branches of the middle cerebral artery in the subpial dissection stage, and the inferior fronto-occipital, uncinate and arcuate fasciculi, and the corona radiata in establishing the deep limits of resection. CONCLUSIONS Procedure-guided study of cerebral hemispheres associating subpial, vascular, and fiber dissection from a surgical standpoint is a powerful tool for the realistic study of the surgical anatomy relevant to frontal transopercular approaches to the insula.
Collapse
Affiliation(s)
- Salvatore Marino
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
- INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, Université de Tours, Tours, France
| | - Guillaume Dannhoff
- INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, Université de Tours, Tours, France
- CHRU de Strasbourg, Strasbourg, France
| | - Christophe Destrieux
- INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, Université de Tours, Tours, France
- CHRU de Tours, Tours, France
| | - Igor Lima Maldonado
- INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, Université de Tours, Tours, France.
- CHRU de Tours, Tours, France.
| |
Collapse
|
2
|
De Schlichting E, Zaldivar-Jolissaint JF, Molter N, Chenevas-Paule M, Hamadmad A, Giroux L, Lazard A, Riethmuller D, Chaffanjon P, Coll G, Lechanoine F. A Comprehensive Training Model for Simulation of Intracranial Aneurysm Surgery Using a Human Placenta and a Cadaveric Head. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01243. [PMID: 38967445 DOI: 10.1227/ons.0000000000001190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/11/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Aneurysmal surgery is technically complex, and surgeon experience is an important factor in therapeutic success, but training young vascular neurosurgeons has become a complex paradigm. Despite new technologies and simulation models, cadaveric studies still offer an incomparable training tool with perfect anatomic accuracy, especially in neurosurgery. The use of human placenta for learning and improving microsurgical skills has been previously described. In this article, we present a comprehensive simulation model with both realistic craniotomy exposure and vascular handling consisting of a previously prepared and perfused human placenta encased in a human cadaveric specimen. METHODS Humans' placentas from the maternity and cadaveric heads from the body donation program of the anatomy laboratory were used. Placentas were prepared according to the established protocol, and aneurysms were created by catheterization of a placental artery. Ten participants, including senior residents or young attendees, completed an evaluation questionnaire after completing the simulation of conventional unruptured middle artery aneurysm clipping surgery from opening to closure. RESULTS The skin incision, muscle dissection, and craniotomy were assessed as very similar to reality. Brain tissue emulation and dissection of the lateral fissure were judged to be less realistic. Vascular management was evaluated as similar to reality as closure. Participants uniformly agreed that this method could be implemented as a standard part of their training. CONCLUSION This model could provide a good model for unruptured aneurysm clipping training.
Collapse
Affiliation(s)
- Emmanuel De Schlichting
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble, France
| | | | | | | | | | - Luc Giroux
- Université de Grenoble Alpes, Grenoble, France
| | - Arnaud Lazard
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble, France
- Université de Grenoble Alpes, Grenoble, France
- Laboratoire d'Anatomie Des Alpes Françaises (LADAF), Université de Grenoble Alpes, Grenoble, France
| | - Didier Riethmuller
- Université de Grenoble Alpes, Grenoble, France
- Service de Gynécologie et Obstétrique, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble, France
| | - Philippe Chaffanjon
- Université de Grenoble Alpes, Grenoble, France
- Laboratoire d'Anatomie Des Alpes Françaises (LADAF), Université de Grenoble Alpes, Grenoble, France
- Service de Chirurgie Thoracique, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble, France
| | - Guillaume Coll
- Service de Neurochirurgie, Centre hospitalier universitaire Gabriel Montpied, Clermont Ferrand, France
| | | |
Collapse
|
3
|
Morichon A, Dannhoff G, Barantin L, Destrieux C, Maldonado IL. Doing more with less: Realistic stereoscopic three-dimensional anatomical modeling from smartphone photogrammetry. ANATOMICAL SCIENCES EDUCATION 2024; 17:864-877. [PMID: 38488189 DOI: 10.1002/ase.2402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 02/19/2024] [Accepted: 02/25/2024] [Indexed: 06/01/2024]
Abstract
Traditional teaching methods struggle to convey three-dimensional concepts effectively. While 3D virtual models and virtual reality platforms offer a promising approach to teaching anatomy, their cost and specialized equipment pose limitations, especially in disadvantaged areas. A simpler alternative is to use virtual 3D models displayed on regular screens, but they lack immersion, realism, and stereoscopic vision. To address these challenges, we developed an affordable method utilizing smartphone-based 360° photogrammetry, virtual camera recording, and stereoscopic display (anaglyph or side-by-side technique). In this study, we assessed the feasibility of this method by subjecting it to various specimen types: osteological, soft organ, neuroanatomical, regional dissection, and a dedicated 3D-printed testing phantom. The results demonstrate that the 3D models obtained feature a complete mesh with a high level of detail and a realistic texture. Mesh and texture resolutions were estimated to be approximately 1 and 0.2 mm, respectively. Additionally, stereoscopic animations were both feasible and effective in enhancing depth perception. The simplicity and affordability of this method position it as a technique of choice for creating easily photorealistic anatomical models combined with stereoscopic depth visualization.
Collapse
Affiliation(s)
- Alex Morichon
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Guillaume Dannhoff
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
- Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | | | - Christophe Destrieux
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
- CHRU de Tours, Tours, France
| | | |
Collapse
|
4
|
Dannhoff G, Morichon A, Smirnov M, Barantin L, Destrieux C, Maldonado IL. Direct Inside-Out Observation of Superficial White Matter Fasciculi in the Human Brain. Brain Connect 2024; 14:107-121. [PMID: 38308471 DOI: 10.1089/brain.2023.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024] Open
Abstract
Background: Recent methodological advances in the study of the cerebral white matter have left short association fibers relatively underexplored due to their compact and juxtacortical nature, which represent significant challenges for both post-mortem post-cortex removal dissection and magnetic resonance-based diffusion imaging. Objective: To introduce a novel inside-out post-mortem fiber dissection technique to assess short association fiber anatomy. Methods: Six cerebral specimens were obtained from a body donation program and underwent fixation in formalin. Following two freezing and thawing cycles, a standardized protocol involving peeling fibers from deep structures towards the cortex was developed. Results: The inside-out technique effectively exposed the superficial white matter. The procedure revealed distinguishable intergyral fibers, demonstrating their dissectability and enabling the identification of their orientation. The assessment of layer thickness was possible through direct observation and ex vivo morphological magnetic resonance imaging. Conclusion: The inside-out fiber technique effectively demonstrates intergyral association fibers in the post-mortem human brain. It adds to the neuroscience armamentarium, overcoming methodological obstacles and offering an anatomical substrate essential for neural circuit modeling and the evaluation of neuroimaging congruence. Impact statement The inside-out fiber dissection technique enables a totally new perception of cerebral connectivity as the observer navigates inside the parenchyma and looks toward the cerebral surface with the subcortical white matter and the cortical mantle in place. This approach has proven very effective for exposing intergyral association fibers, which have shown to be much more distinguishable from an inner perspective. It gave rise to unprecedented images of the human superficial white matter and allowed, for the first time, direct observation of this vast mantle of fascicles on entire cerebral hemisphere aspects.
Collapse
Affiliation(s)
- Guillaume Dannhoff
- Service de Neurochirurgie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
- Université de Tours, INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, 37032, Tours, France
| | - Alex Morichon
- Université de Tours, INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, 37032, Tours, France
| | - Mykyta Smirnov
- Université de Tours, INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, 37032, Tours, France
| | - Laurent Barantin
- Université de Tours, INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, 37032, Tours, France
| | - Christophe Destrieux
- Université de Tours, INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, 37032, Tours, France
- Service de Neurochirurgie, CHRU de Tours, Tours, France
| | - Igor Lima Maldonado
- Université de Tours, INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, 37032, Tours, France
| |
Collapse
|
5
|
Wang AP, Trivedi A, Karir A, Walker GB, Ragulojan M, Ben Nakhi S, Shakil H, Fahed R, Drake BJ. "Instant 3D" Angiography: Novel Technique for Rapid Conversion of 2D Angiograms into 3D Stereoscopic Videos. World Neurosurg 2023; 179:109-117. [PMID: 37619840 DOI: 10.1016/j.wneu.2023.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Rotational angiography, often referred to as a "spin", is typically presented in 2D. Since rotational angiograms are composed of images acquired from multiple angles, we took advantage of this property to develop a method for converting any rotational angiogram into a 3 dimensional (3D) video. METHODS Our aim was to develop a low cost and easily distributable solution without requiring additional hardware or altering acquisition techniques. Six previously acquired rotational angiograms from our institution were imported using custom-written code and exported as anaglyph (red-cyan) videos. RESULTS The resulting 3D videos convey anatomical depth that is not apparent from viewing the 2D images alone. Processing time was 1.3 ± 0.6 s (mean ± SD) per angiogram. The only associated cost was $10 for red-cyan 3D glasses. Using our software, any rotational angiogram with at least 0.3 frames per degree of rotation can be converted into 3D. CONCLUSIONS Our solution is an inexpensive and rapid method for generating stereoscopic videos from existing angiograms. It does not require any additional hardware and is readily deployable in low-resource settings. Because the videos are in anaglyph format, they are viewable on any 2 dimensional (2D) display in the interventional suite or operating room, on a mobile device, or at home.
Collapse
Affiliation(s)
- Alick P Wang
- Department of Bioengineering, Faculty of Engineering, Imperial College London, London, United Kingdom; Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
| | - Arunachala Trivedi
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Aneesh Karir
- Department of Bioengineering, Faculty of Engineering, Imperial College London, London, United Kingdom; Section of Plastic Surgery, Department of Surgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gregory B Walker
- Division of Neurology, Department of Medicine, Royal Columbian Hospital, University of British Columbia, Westminster, British Columbia, Canada
| | - Malavan Ragulojan
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Saleh Ben Nakhi
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Husain Shakil
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robert Fahed
- Division of Interventional Neuroradiology, Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian J Drake
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada; Division of Interventional Neuroradiology, Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
6
|
Anaglyph stereo virtual dissection: a novel inexpensive method for stereoscopic visualisation of intracardiac anatomy on CT angiogram. Cardiol Young 2021; 31:1958-1961. [PMID: 33851903 DOI: 10.1017/s1047951121001323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Three-dimensional visualisation is invaluable for evaluating cardiac anatomy. Patient-specific three-dimensional printed models of the heart are useful but require significant infrastructure. The three-dimensional virtual models, derived from 3D echocardiography, computed tomographic (CT) angiography or cardiac magnetic resonance (CMR), permit excellent visualisation of intracardiac anatomy, but viewing on a two-dimensional screen obscures the third dimension. Various forms of extended reality, such as virtual reality and augmented reality, augment the third dimension but only using expensive equipment. Herein, we report a simple technique of anaglyph stereoscopic visualisation of three-dimensional virtual cardiac models. The feasibility of achieving stereovision on a personal computer, using open-source software, and the need for inexpensive anaglyph glasses for viewing make it extremely cost-effective. Further, the retained depth perception of resulting stereo images in electronic and printed format makes sharing with other members of the team easy and effective.
Collapse
|
7
|
Smirnov M, Destrieux C, Maldonado IL. Cerebral white matter vasculature: still uncharted? Brain 2021; 144:3561-3575. [PMID: 34718425 DOI: 10.1093/brain/awab273] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/17/2021] [Accepted: 07/11/2021] [Indexed: 11/14/2022] Open
Abstract
White matter vasculature plays a major role in the pathophysiology of permanent neurological deficits following a stroke or progressive cognitive alteration related to small vessel disease. Thus, knowledge of the complex vascularization and functional aspects of the deep white matter territories is paramount to comprehend clinical manifestations of brain ischemia. This review provides a structured presentation of the existing knowledge of the vascularization of the human cerebral white matter from seminal historical studies to the current literature. First, we revisit the highlights of prenatal development of the endoparenchymal telencephalic vascular system that are crucial for the understanding of vessel organization in the adult. Second, we reveal the tangled history of debates on the existence, clinical significance, and physiological role of leptomeningeal anastomoses. Then, we present how conceptions on white matter vascularization transitioned from the mixed ventriculopetal/ventriculofugal theory, in which a low-flow area was interposed in between concurrent arterial flows, to the purely ventriculopetal theory. The latter model explains variable white matter sensitivity to ischemia by various organizations of ventriculopetal vessel terminals having different origin/length properties and interconnection patterns. Next, arteries supplying primarily the white matter are described according to their length and overall structure. Furthermore, the known distribution territories, to date, are studied in relation to primary anatomical structures of the human cerebral white matter, emphasizing the sparsity of the "ground-truth" data available in the literature. Finally, the implications for both large vessel occlusion and chronic small vessel disease are discussed, as well as the insights from neuroimaging. All things considered, we identify the need for further research on deep white matter vascularization, especially regarding the arterial supply of white matter fiber tracts.
Collapse
Affiliation(s)
- Mykyta Smirnov
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Christophe Destrieux
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,CHRU de Tours, Tours, France
| | | |
Collapse
|
8
|
Jacquesson T, Simon E, Dauleac C, Margueron L, Robinson P, Mertens P. Stereoscopic three-dimensional visualization: interest for neuroanatomy teaching in medical school. Surg Radiol Anat 2020; 42:719-727. [PMID: 32114650 DOI: 10.1007/s00276-020-02442-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The anatomy of both the brain and the skull is particularly difficult to learn and to teach. Since their anatomical structures are numerous and gathered in a complex tridimensional (3D) architecture, classic schematical drawing or photography in two dimensions (2D) has difficulties in providing a clear, simple, and accurate message. Advances in photography and computer sciences have led to develop stereoscopic 3D visualization, firstly for entertainment then for education. In the present study, we report our experience of stereoscopic 3D lecture for neuroanatomy teaching to early medical school students. METHODS High-resolution specific pictures were taken on various specimen dissections in the Anatomy Laboratory of the University of Lyon, France. Selected stereoscopic 3D views were displayed on a large dedicated screen using a doubled video projector. A 2-h stereoscopic neuroanatomy lecture was given by two neuroanatomists to third-year medicine students who wore passive 3D glasses. Setting up lasted 30 min and involved four people. The feedback from students was collected and analyzed. RESULTS Among the 483 students who have attended the stereoscopic 3D lecture, 195 gave feedback, and all (100%) were satisfied. Among these, 190 (97.5%) reported a better knowledge transfer of brain anatomy and its 3D architecture. Furthermore, 167 (86.1%) students felt it could change their further clinical practice, 179 (91.8%) thought it could enhance their results in forthcoming anatomy examinations, and 150 (76.9%) believed such a 3D lecture might allow them to become better physicians. This 3D anatomy lecture was graded 8.9/10 a mean against 5.9/10 for previous classical 2D lectures. DISCUSSION-CONCLUSION The stereoscopic 3D teaching of neuroanatomy made medical students enthusiastic involving digital technologies. It could improve their anatomical knowledge and test scores, as well as their clinical competences. Depending on university means and the commitment of teachers, this new tool should be extended to other anatomical fields. However, its setting up requires resources from faculties and its impact on clinical competencies needs to be objectively assessed.
Collapse
Affiliation(s)
- Timothée Jacquesson
- Department of Anatomy, Faculté de médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon I, 8 Avenue Rockefeller, 69003, Lyon, France. .,Skull Base Multi-Disciplinary Unit, Department of Neurosurgery, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon, France.
| | - Emile Simon
- Department of Anatomy, Faculté de médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon I, 8 Avenue Rockefeller, 69003, Lyon, France.,Department of Functional Neurosurgery, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon, France
| | - Corentin Dauleac
- Department of Anatomy, Faculté de médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon I, 8 Avenue Rockefeller, 69003, Lyon, France
| | - Loïc Margueron
- Department of Anatomy, Faculté de médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon I, 8 Avenue Rockefeller, 69003, Lyon, France
| | - Philip Robinson
- Department of Clinical Research and Innovation, Hospices Civils de Lyon, Lyon, France
| | - Patrick Mertens
- Department of Anatomy, Faculté de médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon I, 8 Avenue Rockefeller, 69003, Lyon, France.,Department of Functional Neurosurgery, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon, France
| |
Collapse
|