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The frontotemporal-orbitozygomatic (FTOZ) approach is widely used for accessing anterolateral lesions in skull base surgery. Many studies have described the technique and quantified the surgical exposure and freedom provided by the FTOZ approach. However, few studies have provided a detailed analysis of the technique and surgical landmarks using three-dimensional (3D) models. In this study, we aimed to create a collection of volumetric models (VMs) and stereoscopic media on the step-by-step surgical technique of the FTOZ approach using cadaveric dissections. The FTOZ approach was divided into eight major steps: positioning, incision of the skin, dissection of scalp flap, mobilization of the temporalis muscle, dissection of periorbita, craniotomy, drilling of basal structures, and dural opening. The MacCarty keyhole and inferior orbital fissure are major surgical landmarks that were referenced for the six bony cuts. Photogrammetry and structured light scanning were used to construct high-resolution VMs. We illustrated the two-piece FTOZ craniotomy, followed by the one-piece and three-piece FTOZ craniotomies. Stereoscopic images, videos, and VMs were produced for each step of the surgical procedure. In addition, the mini-orbitozygomatic (MOz) and orbitopterional (OPt) approaches were considered and described as possible alternatives to the FTOZ approach. Recent advances in 3D technology can be implemented in neurosurgical practice to further enhance our spatial understanding of neurovascular structures. Surgical approaches should be carefully selected and tailored according to the patient's unique pathology and needs.

In this study we aim to evaluate the feasibility of creating volumetric models of highly intricate skull-base anatomy—previously not amenable to volumetric reconstruction—using endoscopic endonasal approaches. Ten human cadaveric heads were dissected through the nasal corridor to expose anterior, middle, and posterior cranial fossi structures and the pterygopalatine and infratemporal fossi. A rigid endoscope with a 30° lens was used to capture the images. Subsequently, a photogrammetry software was used to align, smooth, and texturize the images into a complete 3-dimensional model. An average of 174 photographs were used to construct each model (n = 10). In the end, we achieved high-definition stereoscopic volumetric models of the nasal corridor; paranasal fossae; and anterior, middle and posterior fossae structures that preserved structural integrity. Strategic points of interests were labeled and animated for educational use. Endoscopic volumetric models represent a new way to depict the anatomy of the skull base; their use with 3-dimensional technologies could potentially improve the visuospatial understanding of narrow surgical corridors for education and surgical-planning purposes. [ABSTRACT FROM AUTHOR]

Visuospatial features of neuroanatomy are likely the most difficult concepts to learn in anatomy. Three-dimensional (3D) modalities have gradually begun to supplement traditional 2-dimensionanl representations of dissections and illustrations. We have introduced and described the workflow of 2 innovative methods—photogrammetry (PGM) and structured light scanning (SLS)—which have typically been used for reverse-engineering applications. In the present study, we have described a novel application of SLS and PGM that could enhance medical education and operative planning in neurosurgery. We have described the workflow of SLS and PGM for creating volumetric models (VMs) of neuroanatomical dissections, including the requisite equipment and software. We have also provided step-by-step procedures on how users can postprocess and refine these images according to their specifications. Finally, we applied both methods to 3 dissected hemispheres to demonstrate the quality of the VMs and their applications. Both methods yielded VMs with suitable clarity and structural integrity for anatomical education, surgical illustration, and procedural simulation. The application of 3D computer graphics to neurosurgical applications has shown great promise. SLS and PGM can facilitate the construction of VMs with high accuracy and quality that can be used and shared in a variety of 3D platforms. Similarly, the technical demands are not high; thus, it is plausible that neurosurgeons could become quickly proficient and enlist their use in education and surgical planning. Although SLS is preferable in settings in which high accuracy is required, PGM is a viable alternative with a short learning curve. [ABSTRACT FROM AUTHOR]