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Every finitely presented group is the fundamental group of a closed connected smooth oriented four-manifold. Build a compact four-dimensional handle decomposition with one zero-handle, a one-handle for each generator of a group and a two-handle for each relator. Turning the handle decomposition upside down shows that its boundary surjects on the fundamental group. Its double of a manifold has the same fundamental group by the Seifert-van Kampen theorem.

All homology and cohomology in this solution use ${\mathbb{F}}_2$ coefficients, so no orientation hypothesis is necessary. The Poincare-Lefschetz duality degrees are complementary:The starred notation in the question must be understood with this degree reversal.

Turn the handle decomposition upside down. An absolute $k$-handle becomes a relative $(n-k)$-handle based on $\partial W$. The absolute cellular boundary coefficient counts intersections of an attaching sphere with a belt sphere. In the reversed handle decomposition, the same intersections are counted in the opposite order. Over ${\mathbb{F}}_2$ the two incidence matrices are transposes, with no sign ambiguity. Thus the absolute chain complex is the complementary-degree dual of the relative chain complex. Taking homology and using the universal coefficient theorem for cohomology over a field proves the displayed isomorphism. This is mod-two handle duality.

To obtain a perfect pairing from the assumed closed case, form the double of a manifold $D(W)$ from two copies of $W$. The fold map $D(W)\to W$ is a retraction, so the inclusion of either copy induces an injection on homology. If $a\ne 0$ in $H_k(W)$, its image in $H_k(D(W))$ is nonzero. Closed-manifold mod-two Poincare duality supplies a class $z\in H_{n-k}(D(W))$ with intersection $1$ against that image. Cut a representative of $z$ along the boundary and retain its part in the first copy; it defines $b\in H_{n-k}(W,\partial W)$. Equivalently, apply the quotient map $D(W)\to D(W)/W_{-}\cong W/\partial W$ and excision. Intersections with a representative of $a$ in the interior are unchanged, so $a\cdot b=1$. This proves nondegeneracy in the first variable. Mod-two handle duality gives equal finite dimensions for the two spaces, hence nondegeneracy in the second variable as well.

For the three-dimensional conclusion, setThe long exact sequence in relative homology says $L=\mathrm{im}\partial$, where $\partial :H_2(W,\partial W)\to V$. The closed-surface intersection pairing on $V$ is nondegenerate. A collar calculation gives the adjoint identityIndeed, push $x$ slightly into the collar: intersections with the relative surface representing $b$ correspond to its boundary intersections with $x$. By the absolute-relative perfect pairing already proved, $x$ is orthogonal to every $\partial b$ precisely when $i_{\ast }x=0$. Therefore $L^{\perp }=L$.

For any finite-dimensional space with a perfect pairing, $\dim L+\dim L^{\perp }=\dim V$. Hence the half-lives-half-dies theorem givesBut $H_1({\mathbb{RP}}^2;{\mathbb{F}}_2)\cong {\mathbb{F}}_2$ has dimension one. It cannot be the entire boundary of a compact three-manifold, because the displayed dimension would be $1/2$. This excludes nonorientable three-manifolds as well as orientable ones.

A closed connected three-manifold has a handle decomposition with one zero-handle and one three-handle. To arrange this, cancel the zero-handles along a spanning tree of connecting one-handles; perform the corresponding construction in the dual handle decomposition to consolidate the three-handles. This does not require the three-manifold to be orientable.

If there are $r$ one-handles and $s$ two-handles, the Euler characteristic isMod-two Poincare duality pairs the Betti numbers of a closed odd-dimensional manifold, giving $\chi (Y)=0$. Thus $r=s$. The one-handles give $r$ generators of a group of the fundamental group, the attaching circles of the two-handles give $r$ relators, and the three-handle does not change the fundamental group. Therefore ${\pi }_1(Y)$ admits a balanced presentation.

Now letbe any finite group presentation. Start with a four-dimensional zero-handle and $r$ one-handles. Its fundamental group is the free group on the $x_i$. Represent the finitely many relators by disjoint embedded circles in its three-dimensional boundary; a small perturbation makes the circles disjoint. Choose framings of an embedded sphere and attach $s$ two-handles. The resulting compact connected oriented four-manifold $W$ has ${\pi }_1(W)\cong G$ by the Seifert-van Kampen theorem.

The map ${\pi }_1(\partial W)\to {\pi }_1(W)$ is surjective. One way to see this is to turn the handle decomposition upside down: the relative handles based on $\partial W$ have indices $2,3,4$, and so add no fundamental group generators. Also $\partial W$ is connected, since surgery on embedded circles in a connected three-manifold preserves connectedness.

Take the double of a manifoldIt is a closed connected smooth oriented four-manifold. The Seifert-van Kampen theorem givesBoth maps from ${\pi }_1(\partial W)$ are the same surjection, under the natural identification of the two copies. The pushout identifies the two copies of every element of $G$ and imposes no new relations: the fold homomorphism is inverse to either inclusion. ThusThis is four-manifold realization of finitely presented groups.