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    Creating a neuroanatomy education model with augmented reality and virtual reality simulations of white matter tract
    (874, 2024) Gürses, Muhammet Enes; Gökalp, Elif; Gecici, Neslihan Nisa; Güngör, Abuzer; Berker, Mustafa; Ivan, Michael E.; Komotar, Ricardo J.; Cohen-Gadol, Aaron A.; Türe, Uǧur
    OBJECTIVE The utilization of digital technologies has experienced a notable surge, particularly in cases where access to cadavers is constrained, within the context of practical neuroanatomy training. This study evaluates augmented reality (AR)- and virtual reality (VR)-based educational models for neuroanatomy education. METHODS Three-dimensional models were created using advanced photogrammetry. VR- and AR-based educational models were developed by arranging these 3D models to align with the learning objectives of neurosurgery residents and second-year medical students whose cadaveric training was disrupted due to an earthquake in Turkey. Participants engaged with and evaluated the VR- and AR-based educational models, followed by the completion of a 20-item graded user experience survey. A 10-question mini-test was given to assess the baseline knowledge level prior to training and to measure the achievement of learning objectives after training. RESULTS Forty neurosurgery residents were trained with a VR-based educational model using VR headsets. An AR-based educational model was provided online to 200 second-year medical students for their practical neuroanatomy lesson. The average correct answer rates before the training were 7.5/10 for residents and 4.8/10 for students. These rates were significantly improved after the training to 9.7/10 for residents and to 8.7/10 for students (p < 0.001). Feedback from the users concurred that VR- and AR-based training could significantly enhance the learning experience in the field of neuroanatomy. CONCLUSIONS VR/AR-based educational models have the potential to improve education. VR/AR-based training systems can serve as an auxiliary tool in neuroanatomy training, offering a realistic alternative to traditional learning tools. © AANS 2024.
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    Microsurgical Resection of a PediatricTegmentum Tumor Through the Paramedian Supracerebellar Transtentorial Approach with the Tentorial Cut Technique: 2-Dimensional Operative Video
    (Lippincott Williams and Wilkins, 2024) Rahmanov, Serdar; Doǧruel, Yücel; Güngör, Abuzer; Türe, Uǧur
    The brainstem contains a highly complex group of nuclei and major white matter tracts within a small volume.1 The complex nature of its anatomy creates challenges for surgery in this area, impeding the standardization of approaches. Therefore, the concept of the "safe entry zone" should be considered with caution, and the strategy for each patient should be tailored based on the relevant subunit of the brainstem and individual patient characteristics. The critical parameter to target in patients is achieving the highest possible extent of resection while preserving function.1 The paramedian supracerebellar transtentorial approach is usually suitable for midbrain lesions. This approach allows for targeting tegmental tumors through the posterolateral midbrain surface.1 It is typically performed through a paramedian suboccipital craniotomy, ideally with the patient in the semisitting position, and is now considered a standard and safe approach.2 In patients with a spontaneous atrial right-to-left shunt, lateral or semilateral positions are viable alternatives, with the semilateral preferred for intraoperative magnetic resonance imaging.1 The cerebellar hemispheric tentorial bridging veins are usually located in the surgical route, narrowing the surgical corridor.3 Sacrifice or unintended rupture of these veins can sometimes lead to unexpected serious complications. Therefore, it is essential to preserve these veins during supracerebellar approaches.3 In this study, we demonstrate the resection of a pediatric tegmentum tumor through the left-sided paramedian supracerebellar transtentorial approach. In addition, we show the tentorial cut technique used to preserve the cerebellar hemispheric tentorial bridging veins. The patient's parents consented to the procedure and to the publication of his image. © 2024 Lippincott Williams and Wilkins. All rights reserved.
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    Sublabial transmaxillary approach to the inferior aspect of the orbit
    (American Association of Neurological Surgeons, 2025) Doǧruel, Yücel; Güngör, Abuzer; Türe, Hatice; Türe, Uǧur
    OBJECTIVE The objective was to demonstrate the surgical steps and outcomes of the sublabial transmaxillary microsurgical approach with endoscopic assistance to treat lesions in the inferior aspect of the orbit, as well as to describe the use of patient-specific 3D models to facilitate surgical preparation and improve experience with the technique. METHODS The authors' study evaluated data from patients who underwent an endoscope-assisted sublabial transmaxillary approach for inferior orbital lesions. For 2 patients, 3D models were created for preoperative planning and assessment of the approach. Surgical steps comprised osteotomy to access the maxillary sinus, bony resection of the orbital floor, opening of the periorbital fascia, and dissecting and removing the lesion, followed by closure. The neuroendoscope was used to inspect the surgical cavity between each step. RESULTS The study included 5 patients with varying visual field defects and proptosis who underwent the sublabial transmaxillary microsurgical approach with endoscopic assistance. Complete resection was achieved in all, and all patients reported improvement in visual field defects and proptosis after the procedure. No complications were observed except for transient unilateral maxillary edema noted around the incision site in 3 patients during the early postoperative period, which resolved within a few days. Histopathological examination confirmed the diagnosis of cavernous malformation in all patients. CONCLUSIONS The sublabial transmaxillary approach is a direct and safe method to resect cavernous malformations at the inferior aspect of the orbit. It reduces the risk of complications associated with lateral, transcranial, and transnasal approaches that may cross critical structures. The microsurgical approach provides the benefit of two-handed dissection for lesions embedded in orbital fat, which can be challenging because of adhesions to surrounding tissues. The use of 3D models can facilitate surgical planning and enhance familiarity with the approach. © AANS 2025.