The Anatomy Laboratory Toward Visuospatial Surgical Innovation in Otolaryngology and Neurosurgery (ALT-VISION) at The Ohio State University Wexner Medical Center leads the world in educating surgeons and advancing skull base surgery technology.
A research and education lab, ALT-VISION allows visiting researchers to work with cadaveric specimens and 3D neuronavigation techniques to learn, refine and develop surgical approaches or conduct specific anatomical research.
“Skull base surgery is a very complex anatomical area,” says Ricardo Carrau, MD, co-director of ALT-VISION and professor of Otolaryngology – Head and Neck Surgery at the Ohio State Wexner Medical Center. “It requires the surgeon to study anatomy in detail because it’s very complex and full of things critical for life. That’s why the laboratory has become so important.”
2024 was a banner year for many reasons, including ALT-VISION hosting 15 visiting scholars from around the world. Researchers with the lab also published 35 studies based on surgical skull base dissections and techniques of treatment of brain tumors — a record number. Five of those papers were chosen as The Poster of Distinction at the 33rd North American Skull Base Society (NASBS) meeting held in Atlanta, Georgia. Two papers were featured for the July and September 2024 covers of the Operative Neurosurgery Journal (September 2024, Volume 27: Issue 3, July 2024, Volume 27: Issue 1), and one paper was featured for the December 2024 cover of the Journal of Neurosurgery (January 2025, Volume 142: Issue 1).
One abstract, by Moataz Abouammo, MD, MSc, associate researcher and coordinator at ALT-VISION, received the prestigious Rhoton Award from the NASBS. The award recognizes the best abstract addressing skull base anatomy via cadaveric dissection, morphometric analysis, radiographic modalities or computer simulation. The abstract was titled “Expanding the Inferior Access to the Craniovertebral Junction through Contralateral Nasofrontal Trephination and Posterior Palatectomy: A Cadaveric Comparative Study with Quantitative Analysis.”
The lab also initiated a 3D photogrammetry project, which creates interactive 3D educational anatomical models for cranial and skull base dissections. “The Ventral Skull Base Atlas of Endoscopic Sinus and Anterior Skull Base Surgery Interactive 3D Dissection Manual” was first introduced in the department’s annual skull base dissection course.
In 2024, two novel surgical approaches by Dr. Abouammo emerged from the lab, were successfully implemented in clinical settings to treat patients with brain and skull base tumors, and yielded impressive results (Contralateral Nasofrontal Trephination: A Novel Corridor for a “Dual Port” Approach to the Petrous Apex, The Nasopharyngo-Septal Butterfly Flap: A Novel Adjunct for Reconstructing Large Skull Base Defects).
Dr. Carrau compares it to real estate platforms that allow potential home buyers to enter a house virtually and “move” from room to room. “You have a certain part of the skull, and we can go in any direction and rotate it. The structures are labeled so users can learn the anatomy as they go.”
Moving forward, the ALT-VISION lab is developing an application for surgeons to download images of different techniques. Originally initiated as a printed course manual, the new app contains videos and interactive 3D models. Each 3D model leverages 2,000 to 3,000 cadaveric dissection images and uses artificial intelligence (AI) and dedicated 3D software to link them. The manual harbor and distribution is sponsored by the educational branch of Medtronic Corporation, but owned by The Ohio State University.
Originally, the ALT-VISION lab tested surgical devices for companies. As it evolved, the ALT-VISION lab began producing and designing instruments and simulation models.
“Our main purpose remains anatomy of the skull base from a surgical perspective,” says Dr. Carrau. “This type of lab is not very common. There are only two that I know of: ours and one at Stanford University.”
To date, more than 200 scholars from around the world have taken advantage of the expertise and facilities provided by the ALT-VISION lab.