A Comprehensive Three-Dimensional Simulation Method for Skull Base Meningioma Surgery

Preoperative planning for skull base meningioma surgery requires a detailed understanding of complex anatomical relationships and careful strategy development. Although three-dimensional (3D) simulation has been increasingly used for surgical planning, conventional simulations mainly visualize anatomical structures and rarely reproduce the sequential process of tumor removal. We developed a method to perform a near-complete digital 3D simulation of skull base meningioma surgery using a surgical simulation application. Preoperative imaging data in Digital Imaging and Communications in Medicine (DICOM) format were imported into a simulation platform that automatically generated 3D models of the brain, vasculature, skull, cranial nerves, and tumor through artificial intelligence-based segmentation. Additional reconstruction techniques were applied to create a virtual dura mater. By combining built-in functions for tissue retraction and drill-based removal and labeling the tumor as a removable structure, the simulation reproduced key surgical steps, including craniotomy, tumor detachment from the dural attachment, internal debulking, and dissection from surrounding neurovascular structures. This method was applied to a 59-year-old woman with a symptomatic anterior clinoidal meningioma compressing the optic nerve and encasing the terminal portion of the internal carotid artery. Preoperative simulation reproduced the planned surgical workflow, including frontotemporal craniotomy, anterior clinoidectomy, tumor detachment, compartmental debulking, and dissection from adjacent vessels and the optic nerve. Intraoperative findings closely corresponded to the simulated procedure, and gross total resection was achieved without neurological complications. Near-complete digital simulation of skull base meningioma surgery may facilitate visualization of operative strategies and procedural steps in complex cases. This approach has the potential to serve as a useful tool for surgical planning and neurosurgical training.