Three Dimensional Educational Module of the Anatomical Human Brainstem Including Vascular Territories
Authors: Nguyen Andrew Hoang‐Son , Hisley Kenneth , Eliot David 
Published: November 2023

Objective

To design, create, and test an innovative digital interactive method supporting improved student understanding of complex three‐dimensional (3D) basic and clinical neuroanatomy. This digital model comprises a 3D educational module of human brainstem medullary neuroanatomy with clinically‐correlative 3D vascular territory overlays and an example clinical test case. This effort is intended to provide the foundation for a complete educational model of the human brainstem.

Design

The Educational Module

In order to create the 3D polymesh model of the brainstem we utilized a precise stereotaxic atlas of the human brainstem contained within “The Human Nervous System 3rd ed” (Paxinos & Kai, 2011). This atlas contains 1mm sections of the human brainstem registered within a stereotaxic coordinate system with the origin located at the obex. Key neuroanatomical tracts and nuclei structures were identified in each section and contoured using Reconstruct, a digital tomographic 2D to 3D modeling software application. The vascular perfusion territory overlay volumes were estimated and contoured using Neuroanatomy: An Atlas of Structures (Haines, 2006) as a source reference and using the same methodology. A clinical case of lateral medullary syndrome (Wallenberg Syndrome) was adapted from a 1999 case report from the University of South Alabama Medical Center. Once all of the polymesh objects were completed they were exported to Atlas3D, an atlas compiling software, for visualization and manipulation. Information for the text component of the module was referenced from several neuroanatomical atlases.

User study

Two instruments were created for the user study: 1) a subjective survey (adapted from Hu, et. al) and 2) an academic assessment. The subjective survey examines user perception of the models interface and content. The academic assessment measures the models efficacy in teaching the neuroanatomy of the medulla oblongata in terms of identifying neuroanatomical structures, spatial and rotational relationships, and standard neuroanatomical information. The intended experimental population will consist of 16 Touro University – CA MSMHS students. The subjects will be randomly divided into control and experimental groups, each consisting of 8 students. The control group will receive the standard teaching material the university currently uses, and the experimental group will receive the educational module. Each group will be given the same subjective survey and the same academic assessment.

Results

We created a 3D digital polymesh learning model for the medulla oblongata (from the spinal cord to the obex) which has the ability to be manipulated spatially and also in terms of visual variables (i.e. color and transparency). The resulting educational module contains the following 3D polymesh models: 21 individual neuroanatomical structures of the medulla oblongata and the vascular territories for the anterior and posterior spinal arteries, the vertebral artery, and the posterior inferior cerebellar artery. Six of the 21 neuroanatomical structures are related to the chosen clinical case. Thereafter, three lessons with operational instructions and neuroanatomical information were developed for the 3D model and its stroke‐related clinical correlates. A user study, including testing instruments, has also been developed and will be applied to test the effectiveness of the module in terms of the learning metrics mentioned above.