J Neurol Surg B Skull Base 2022; 83(S 02): e298-e305
DOI: 10.1055/s-0041-1729975
Original Article

Operative Anatomy of the Skull Base: 3D Exploration with a Highly Detailed Interactive Atlas

Ralf A. Kockro
1   Department of Neurosurgery, Hirslanden Hospital, Zürich, Switzerland
2   Department of Neurosurgery, University of Mainz, Mainz, Germany
Eike Schwandt
2   Department of Neurosurgery, University of Mainz, Mainz, Germany
Florian Ringel
2   Department of Neurosurgery, University of Mainz, Mainz, Germany
1   Department of Neurosurgery, Hirslanden Hospital, Zürich, Switzerland
Wieslaw Lucjan Nowinski
3   John Paul II Center for Virtual Anatomy and Surgical Simulation, University of Cardinal Stefan Wyszynski, Warsaw, Poland
› Author Affiliations
Funding None.


Objective We evaluated the usefulness of a three-dimensional (3D) interactive atlas to illustrate and teach surgical skull base anatomy in a clinical setting.

Study Design A highly detailed atlas of the adult human skull base was created from multiple high-resolution magnetic resonance imaging (MRI) and computed tomography (CT) scans of a healthy Caucasian male. It includes the parcellated and labeled bony skull base, intra- and extracranial vasculature, cranial nerves, cerebrum, cerebellum, and brainstem. We are reporting retrospectively on our experiences with employing the atlas for the simulation and teaching of neurosurgical approaches and concepts in a clinical setting.

Setting The study was conducted at the University Hospital Mainz, Germany, and Hirslanden Hospital, Zürich, Switzerland.

Participants Medical students and neurosurgical residents participated in this study.

Results Handling the layered graphical user interface of the atlas requires some training; however, navigating the detailed 3D content from intraoperative perspectives led to quick comprehension of anatomical relationships that are otherwise difficult to perceive. Students and residents appreciated the collaborative learning effect when working with the atlas on large projected screens and markedly improved their anatomical knowledge after interacting with the software.

Conclusion The skull base atlas provides an effective way to study essential surgical anatomy and to teach operative strategies in this complex region. Interactive 3D computer graphical environments are highly suitable for conveying complex anatomy and to train and review surgical concepts. They remain underutilized in clinical practice.

Informed Consent

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


The manuscript does not contain clinical studies or patient data.

Publication History

Received: 10 August 2020

Accepted: 24 February 2021

Article published online:
03 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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