Optimization of skull base exposure using navigation-integrated, virtual reality templates.

In many skull base procedures, arriving at the optimal bone exposure is important. Whereas insufficient exposure can jeopardize the operation itself, over-doing the exposure might lead to complications. We developed a new technique, harnessing the strength of Virtual Reality (VR) technology in planning, rehearsal and navigation, to achieve the optimal skull base exposure for resection of tumors. VR models of patient-specific anatomy were used to rehearse the surgical exposure. From the altered models, the one with the ideal exposure was chosen, integrated with the navigation system in the operating suite, and used as a template to achieve the optimal exposure in surgery. The use of these VR templates is demonstrated in two cases involving skull base tumors. In both cases, over-zealous bone removal could have increased the risk of complications, and inadequate exposure would jeopardize the tumor resection. Navigation guided by the VR templates aided the creation of the "ideal" surgical exposure to reach the surgical goals. Complete resections were achieved and neither patient suffered any approach-related complications. In conclusion, virtual reality is a powerful tool to improve the safety and efficacy of neurosurgical procedures. With preoperatively-altered VR templates, the surgeon is no longer navigating just to find bearings, but to duplicate an opening designed to simultaneously provide sufficient exposure while limiting postoperative complications. Intuitively useful and successful in early application, there has been no identifiable disadvantages to date.