Virtual Exploration of Safe Entry Zones in the Brainstem: Comprehensive Definition and Analysis of the Operative Approach

Abstract

Background: Detailed and accurate understanding of intrinsic brainstem anatomy and the interrelationship between its internal tracts and nuclei and external landmarks is of paramount importance for safe and effective brainstem surgery. Using anatomical models can be an important step in sharpening such understanding.Objective: To show the applicability of our developed virtual 3D model in depicting the safe entry zones (SEZs) to the brainstem.Methods: Accurate 3D virtual models of brainstem elements were created using high-resolution magnetic resonance imaging and computed tomography to depict brainstem SEZs.Results: All the described SEZs to different aspects of the brainstem were successfully depicted using our 3D virtual models. Conclusions:The virtual models provide an immersive experience of brainstem anatomy, allowing users to understand the intricacies of the microdissection that is necessary to appropriately traverse the brainstem nuclei and tracts toward a particular target. The models provide an unparalleled learning environment for illustrating SEZs into the brainstem that can be used for training and research.

Prognosis and Influencing Factors of Early Microsurgery for Severe Hypertensive Brainstem Hemorrhage

“…If the hematoma is close to the surface of the brainstem, color changes or local uplift occurs, and the hematoma cavity can be accessed by cutting the brainstem longitudinally in the local lesion [ 9 , 19 ]. If the hematoma is confined to the brainstem tissue and there is no change on the surface, the hematoma cavity can be accessed through the safe entry zone [ 11 , 12 ]. In addition, during the hematoma clearance, the brainstem supplying arteries and draining veins should be avoided as much as possible so as to avoid iatrogenic injury.…”

“…With the in-depth study of the anatomical structure and physiological function of the brainstem, it was confirmed that there is a relatively “safe operation area” in the brainstem [ 10 – 12 ]. Microsurgery is expected to become one of the most important ways to improve the prognosis of SHBSH patients [ 2 , 11 ]. Nevertheless, whether surgical treatment could improve the prognosis of patients with brainstem hemorrhage still remains controversial [ 13 , 14 ].…”