Learning Brainstem Anatomy using App in the CG Simulation Era

Abstract

  The choice of surgical approach is among the most important considerations in the surgical study of brainstem cavernous malformations. Specific considerations include whether the approach is the one with the lowest likelihood of worsening neurological symptoms, whether a field of view can be secured so that the lesion can be completely removed, and whether the complicated developmental venous anomaly can be preserved. Furthermore, it is necessary to consider a three-dimensional surgical approach in which the lesion on the most superficial part of the brainstem is the most accessible point. Accordingly, knowledge of normal anatomy and safe entry zones (SEZs) is critical. No-kan is a free app developed by the Department of Neurosurgery at the University of Tokyo that allows users to study the anatomy of the brainstem and SEZs. The app shows numerous cranial nerves, nuclei, and white matter fibers present in the brainstem as three-dimensional computer graphics. The points of surgical approach to 16 SEZs reported in 21 studies are also described. With the aim of promoting understanding of the surgical anatomy of the brainstem in three dimensions, this paper outlines the anatomy of the brainstem focusing on SEZs, with reference to 3D computer graphics in the No-kan app.