Foundations of Advanced Neuroanatomy: Technical Guidelines for Specimen Preparation, Dissection, and 3D-Photodocumentation in a Surgical Anatomy LaboratoryAcknowledgments The authors are grateful to the Neurosurgery Research and Education Foundation, for their extraordinary support of these research activities, as well as the legacy of Prof. Rhoton throughout the community of academic neurosurgery. The authors also acknowledge the support received from Mr. Shaun G. Heath, Mr. Joshua Lopez, and Dr. Michael Smith.
The Northeast Prof. Rhoton Skull Base Dissection Laboratory, Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, New York received funds from the NREF through the Young Investigator Award 2017, given to M.P.C., and received grants from Medtronic, Stryker, and Storz.
The Mayo Clinic Skull Base Research Laboratory was partially founded by the Endowment for Education Research Award, awarded by the Mayo Clinic Foundation to M.J.L. (PI), and M.P.C. (collaborator).
This study was financed in part by the “Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES) - Finance Code 001” which contributed funding L.C.P.C.L. during his fellowship in the Skull Base Dissection Laboratory in the Department of Neuroscience and Experimental Therapeutics in Albany Medical Center, Albany, New York.
22 March 2019
18 July 2019
28 November 2019 (online)
Objective This study was aimed to provide a key update to the seminal works of Prof. Albert L. Rhoton Jr., MD, with particular attention to previously unpublished insights from the oral tradition of his fellows, recent technological advances including endoscopy, and high-dynamic range (HDR) photodocumentation, and, local improvements in technique, we have developed to optimize efficient neuroanatomic study.
Methods Two formaldehyde-fixed cadaveric heads were injected with colored latex to demonstrate step-by-step specimen preparation for microscopic or endoscopic dissection. One formaldehyde-fixed brain was utilized to demonstrate optimal three-dimensional (3D) photodocumentation techniques.
Results Key steps of specimen preparation include vessel cannulation and securing, serial tap water flushing, specimen drainage, vessel injection with optimized and color-augmented latex material, and storage in 70% ethanol. Optimizations for photodocumentation included the incorporation of dry black drop cloth and covering materials, an imaging-oriented approach to specimen positioning and illumination, and single-camera stereoscopic capture techniques, emphasizing the three-exposure-times-per-eye approach to generating images for HDR postprocessing. Recommended tools, materials, and technical nuances were emphasized throughout. Relative advantages and limitations of major 3D projection systems were comparatively assessed, with sensitivity to audience size and purpose specific recommendations.
Conclusion We describe the first consolidated step-by-step approach to advanced neuroanatomy, including specimen preparation, dissection, and 3D photodocumentation, supplemented by previously unpublished insights from the Rhoton fellowship experience and lessons learned in our laboratories in the past years such that Prof. Rhoton's model can be realized, reproduced, and expanded upon in surgical neuroanatomy laboratories worldwide.
Keywordsskull base - endoscopy - imaging - three-dimensional photography - dissection - anatomy - neuroanatomy - education
- 1 Fernandez-Miranda JC. Prof. Albert L. Rhoton, Jr.: his life and legacy. World Neurosurg 2016; 92: 590-596
- 2 Matsushima T. Rhoton and his influence on Japanese neurosurgery. World Neurosurg 2016; 92: 608-613
- 3 Robertson JH. Dr. Al Rhoton, Jr.: friend, mentor, and colleague. J Neurol Surg B Skull Base 2016; 77 (04) 291-293
- 4 Robertson JH. Rhoton and the United States. World Neurosurg 2016; 92: 597-600
- 5 Sorenson J. The Rhoton collection. J Neurol Surg B Skull Base 2016; 77 (04) 294-296
- 6 Timurkaynak E. Rhoton and his influence on Turkish neurosurgery. World Neurosurg 2016; 92: 614-616
- 7 Tong X. Rhoton and his influence in Chinese neurosurgery. World Neurosurg 2016; 92: 617-622
- 8 Wen HT, de Oliveira E. Rhoton and his influence in Latin America neurosurgery. World Neurosurg 2016; 92: 606-607
- 9 Martins C, Alencastro LF, Campero A, Rhoton Jr A. Three-dimensional endoscopic photography of anatomic specimens. World Neurosurg 2018; 120: e730-e736
- 10 Martins C, Ribas EC, Rhoton Jr. AL, Ribas GC. Three-dimensional digital projection in neurosurgical education: technical note. J Neurosurg 2015; 123 (04) 1077-1080
- 11 Ribas GC, Bento RF, Rodrigues Jr AJ. Anaglyphic three-dimensional stereoscopic printing: revival of an old method for anatomical and surgical teaching and reporting. J Neurosurg 2001; 95 (06) 1057-1066
- 12 Shimizu S, Tanaka R, Rhoton Jr. AL. , et al. Anatomic dissection and classic three-dimensional documentation: a unit of education for neurosurgical anatomy revisited. Neurosurgery 2006; 58 (05) E1000-E1000 , discussion E1000
- 13 Fernandez-Miranda JC. Prof. Rhoton: master and mentor. J Neurol Surg B Skull Base 2016; 77 (04) 288-290
- 14 Matsushima T, Kobayashi S, Inoue T, Rhoton AS, Vlasak AL, Oliveira E. Albert L. Rhoton Jr., MD: his philosophy and education of neurosurgeons. Neurol Med Chir (Tokyo) 2018; 58 (07) 279-289
- 15 Cohen M, Astur DdaC, Kaleka CC. , et al. Introducing 3-dimensional stereoscopic imaging to the study of musculoskeletal anatomy. Arthroscopy 2011; 27 (04) 593-596
- 16 Sanan A, Abdel Aziz KM, Janjua RM, van Loveren HR, Keller JT. Colored silicone injection for use in neurosurgical dissections: anatomic technical note. Neurosurgery 1999; 45 (05) 1267-1271 , discussion 1271–1274