Interactive Microsurgical Anatomy Education Using Photogrammetry 3D Models and an Augmented Reality Cube: Internal Validation and External Assessment at International Residency Program

Introduction: Plethora of available digital educational resources allows surgical trainees access to alternative learning methods for increasing understanding of complex topics such as microsurgical anatomy. This study incorporates photogrammetry techniques and augmented reality (AR) technology using an inexpensive foam tool (Merge Cube) for neurosurgical anatomic education. The cube with AR marker-based QR (quick response) code detection technology allows users to hold and interact with 3D objects.

Methods: Unique 3D anatomic image models were created using advanced photogrammetry from surgical anatomic dissections and 2D images, registered onto a cube imprinted with unique QR codes. A perspective analysis of the cube system was performed by loading a 3D anatomic model over a motorized turntable to analyze changes in surgical window area according to horizontal rotation. Implementation of the cube as an intraoperative reference guide for surgical trainees was tested during a cadaveric dissection exercise. International neurosurgery residents interacted with and individually assessed the 3D models and cube system.

Results: Three photogrammetry 3D anatomic models were created and imported to the cube. Horizontal turntable rotation of the cube translated to measurable and realistic perspective changes in surgical window area (SWA). Thirty-degree clockwise rotation resulted in a 100%, 81%, and 26% decrease in SWA of the oculomotor tentorial, carotid oculomotor, and optic carotid windows, respectively. Thirty-degree counterclockwise rotation resulted in a 74% decrease in optic carotid SWA. A remote group (n=20) of international residents scored (20/20) the AR experience using the cube system and 3D models as significantly enhancing the learning of neurosurgical anatomy.

Conclusion : The cube allowed manipulation and visualization of highly detailed photogrammetry-based 3D anatomical models. The AR cube combines tactile and visual sensations with high-resolution 3D models of cadaveric dissections. Inexpensive and lightweight, the cube can be effectively implemented to allow independent co-visualization of anatomic dissection and can potentially supplement neurosurgical education.