High-Fidelity Simulation for Skull Base Surgery Enabled by Virtual Dura Mater Construction.

Abstract

Advances in imaging and artificial intelligence have enabled high-resolution three-dimensional (3D) constructions for neurosurgical simulation. However, accurate reproduction of the dura mater-particularly the tentorium, a thin yet critical structure in skull base surgery-remains challenging, limiting the fidelity of preoperative simulations. We describe a novel method for constructing the dura mater in 3D surgical simulation and demonstrate its utility in planning skull base tumor surgery. Magnetic resonance imaging and contrast-enhanced computed tomography were imported into a simulation application (GRID, Kompath, Tokyo). By extracting regions of interest of brain parenchyma and cerebrospinal fluid, smoothing the structures, performing subtraction modeling, and trimming areas corresponding to the brainstem and spinal cord passages, a virtual dura was generated and fused with other anatomical structures. The technique was applied in a case of petrous apex meningioma. Virtual dura construction facilitated detailed comparison of the anterior transpetrosal and lateral suboccipital approaches. Volume analysis showed that 89.6% of the tumor was infratentorial, supporting selection of the lateral suboccipital approach. Intraoperative findings closely matched the simulation, enabling safe and complete tumor removal. This novel technique enables reproducible 3D construction of the virtual dura mater, significantly improving the accuracy of skull base surgery simulations. It provides a valuable educational and decision-making tool, particularly for less-experienced neurosurgeons, bridging the gap toward expert-level surgical planning.