• Matteo de Notaris, Domenico Solari, Luigi Maria Cavallo, Joaquim Enseñat, Isam Alobid, Guadalupe Soria, Joan Berenguer Gonzalez, Enrique Ferrer, and Alberto Prats-Galino.
• Department of Neurosurgery, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
• World Neurosurg. 2011 Jan 1;75(1):106-13; discussion 36-40.

ObjectivesTo apply a three-dimensional geometric model to various endoscopic endonasal approaches to analyze the bony anatomy of this area, quantify preoperatively bone removal, and optimize surgical planning.MethodsInvestigators dissected 18 human cadaveric heads at the Laboratory of Surgical NeuroAnatomy (LSNA) of the University of Barcelona (Spain). Before and after each dissection, a computed tomography (CT) scan was performed to create a three-dimensional geometric model of the approach performed in the dissection room. The model protocol was designed as follows: (i) a preliminary exploration of each specimen using the preoperative CT scan, (ii) creation of a computer-generated three-dimensional virtual model of the approach, (iii) cadaveric anatomic dissection, and (iv) development of a CT-based model of the approach as a result of the superimposition of predissection and postdissection digital imaging and communications in medicine (DICOM) images of specimens.ResultsThis method employing preliminary virtual exploration of each specimen, the creation of a three-dimensional virtual model of the approach, and the overlapping of the predissection and postdissection three-dimensional models was useful to define the exact boundaries of the endoscopic endonasal craniectomy.ConclusionsAside from laboratory anatomic dissection itself, this model is very effective in providing a depiction of bony landmarks and visual feedback of the amount of bone removed, improving the design of the craniectomy in the endoscopic endonasal midline skull base approach.Copyright © 2011 Elsevier Inc. All rights reserved.

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