Introduction: Modern medical education has incorporated anatomical softwares offering a virtual dissection experience. However, cadaver-based dissection simulation provides us with more realistic anatomical view. Due to their labour-intensive nature only a few high-quality cadaver-based 3D virtual dissection simulation models are available worldwide. Our work was inspired by the fact that with the progression of pathological processes affecting the skull base, the orientation of surgeons becomes more difficult with the distortion of anatomical landmarks.

Aim: Our goal is to create unique, interactive 3D dissection simulation models of head and neck surgery using 4D anatomy technology.

This allows special visualisation of basic steps and approaches of skull base surgery to master the specific 3D anatomical view of the surgical field, including the anatomical structures and their relations.

Methods: Layer-by-layer preparation was performed on formalin-fixed head-and-neck torso and cadaver. The dissection steps were captured in spherical scans using 4D Anatomy scanner. The image matrix created in multiple levels was transformed into a swivel interactive model.

Results: Concerning the challenges of the cranial base surgery stem from anatomical complexity and surgical risk, our three main results are as follows:

At the petroclival region the clivus was divided into three parts. The upper third was approached through the orbito-zygomatic craniotomy and according to Kawase’s technique, for the middle third we used various transpetrosal routes and the lower third was accessed by the far lateral approach.

Some advanced space-occupying processes of the lateral skull base may require removal of the jaw and some neck dissection. In these cases reconstructive surgery is essential, therefore the mandible was replaced with fibular flap. 

In a case of a cadaver with a VP shunt inserted bilaterally from Keen’s points we were about to analyze the etiology of the disease. During the extended dissection a considerable amount of blood was observed in the lateral ventricle and a space-occupying pathological disorder was found around the third ventricle.

Conclusion: Our interactive 4D cadaver-based anatomical models are novel visualization opportunities for skull base surgeries, allowing unique visibility of the anatomical structures from special views depending on the different surgical approaches.