Interactive 3D-PDF Presentations for the Simulation and Quantification of Extended Endoscopic Endonasal Surgical Approaches

Abstract

A three-dimensional (3D) model of the skull base was reconstructed from the pre- and post-dissection head CT images and embedded in a Portable Document Format (PDF) file, which can be opened by freely available software and used offline. The CT images were segmented using a specific 3D software platform for biomedical data, and the resulting 3D geometrical models of anatomical structures were used for dual purpose: to simulate the extended endoscopic endonasal transsphenoidal approaches and to perform the quantitative analysis of the procedures. The analysis consisted of bone removal quantification and the calculation of quantitative parameters (surgical freedom and exposure area) of each procedure. The results are presented in three PDF documents containing JavaScript-based functions. The 3D-PDF files include reconstructions of the nasal structures (nasal septum, vomer, middle turbinates), the bony structures of the anterior skull base and maxillofacial region and partial reconstructions of the optic nerve, the hypoglossal and vidian canals and the internal carotid arteries. Alongside the anatomical model, axial, sagittal and coronal CT images are shown. Interactive 3D presentations were created to explain the surgery and the associated quantification methods step-by-step. The resulting 3D-PDF files allow the user to interact with the model through easily available software, free of charge and in an intuitive manner. The files are available for offline use on a personal computer and no previous specialized knowledge in informatics is required. The documents can be downloaded at http://hdl.handle.net/2445/55224 .

Three-Dimensional Portable Document Format (3D PDF) in Clinical Communication and Biomedical Sciences: Systematic Review of Applications, Tools, and Protocols

“…In 11 (7.1%) more articles, it was claimed that 3D PDF should be available, but no 3D model could be found [ 58 , 72 - 81 ]. Of the 156 articles with applied 3D PDF technology, 34 (21.8%) [ 40 , 55 - 57 , 61 , 64 , 68 , 82 - 108 ] had the 3D content directly embedded into the PDF of the article, 94 (60.3%) [ 20 , 48 , 59 , 60 , 63 , 66 , 67 , 109 - 195 ] articles provided the 3D content as supplementary material, and 28 (17.9%) [ 4 , 41 , 62 , 196 - 220 ] referred to an external resource. The 34 articles in which the 3D objects were embedded directly into PDF of the main article were published in 25 different journals.…”

“…Day and colleagues [ 109 ] demonstrated that preoperative 3D modeling of magnetic resonance imaging data of fistula-in-ano can reduce confusion and ambiguity among surgeons when interpreting 3D PDF reports instead of complex textual reports. The benefit of 3D PDF for the simulation of surgical procedures was described by Mavar-Haramija and colleagues [ 4 , 41 ] for endoscopic endonasal interventions. Husch and colleagues [ 192 ] demonstrated how automatically generated 3D PDF reports can be used to visualize and assess the spatial relationships between electrodes and brain structures and to detect misplaced electrodes in a postoperative deep brain stimulation setting.…”

“…Only 2 months later, two more articles with tools for the creation of 3D PDFs were published. Mavar-Haramija and colleagues [ 4 ] presented another commercial software-based protocol that focused on control elements for a more sophisticated interaction with the 3D model. At the same time, Newe and Ganslandt [ 66 ] presented a noncommercial solution for the creation of model files of surface meshes in U3D format that did not require programming skills.…”

“…A PDF document with embedded 3D objects (3D PDF) has high potential in almost every scenario in which 3D objects should be visualized and exchanged between different platforms (eg, computers with different operating systems). A highly relevant use case is the exchange of medical and biomedical data (eg, the visualization of human anatomy for medical students [ 2 ] or clinical data such as the results of surgery planning [ 3 , 4 ]). Therefore, this feature is also considered in the standard AIIM/ASTM BP-01-2008 “Portable Document Format-Healthcare (PDF) A Best Practices Guide” (also known as PDF Healthcare or PDF/H) [ 5 , 6 ].…”

Demonstrating A Rare Anatomical Variation Of Cardiovascular System By Using A New Technique

“…This technique has great potential for almost every scenario wherein 3D objects should be visualized and exchanged between computers with various operating systems. This format widely utilizes biomedical data for the reconstruction of human anatomy to the advantage of medical students or utilizes clinical characteristics for planning surgery ( 3 , 4 ). Besides providing educational information for patients and medical students, 3D PDF offers a very efficient and convenient way to distribute 3D structures by embedding 3D objects into scientific publications especially in digital publications.…”