A simple and cost-effective model for ventricular catheter placement training: technical note

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>External ventricular drain (EVD) placement is one of first cranial procedures neurosurgery residents are expected to perform independently. While proper training improves patient outcomes, there are few options for practicing EVD placement prior to placing the EVD in patients in a clinical setting. Proposed solutions to this include using cadaveric models and virtual simulations, but barriers exist with these as well in regard to authenticity. EVD simulators using virtual reality technologies are a promising new technique for training, but the cost of these devices poses a barrier to general/widespread accessibility among smaller programs or underserved hospitals. The authors desribe a novel, yet simple, and cost-effective technique (less than $5 per mold) for developing a brain model constructed of homemade ballistics gelatin that can be used for teaching and practicing the placement of EVD.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A brain model is made with ballistics gelatin using an anatomically correct skull model as a mold. A 3D-printed ventricular system model is used to create a mold of an anatomically correct ventricular system in the brain model. A group of medical students (n = 10) were given a basic presentation about EVD placement, including standard landmarks and placement techniques, and were also shown a demonstration of EVD placement on the brain model. They were then allowed to perform an EVD placement using the brain model. The students were surveyed on their experience with using the brain model, including usability and practicality of the model. Accuracy of EVD placement by each student was also assessed, with adequate position of catheter tip being in the ipsilateral frontal horn.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The final product is fairly inexpensive and easy to make. It is soft enough to pass a catheter through, but it is also firm enough to maintain its shape, including a cavity representing the lateral ventricles. The dense gelatin holds the catheter in its final resting position, while the two halves are separated and inspected. All participants in the test group of medical students reported that the brain model was easy to use, helped them understand the steps and technique of EVD placement, and provided good feedback on the ideal position of ventricular catheters. All of the participants in the group had adequate positioning of their ventricular catheters after one attempt.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The presented brain model is easy to replicate, inexpensive, anatomically accurate, and provides a medium for neurosurgeons to teach and practice ventricular catheter placement in a risk-free environment.</jats:p></jats:sec>

External Ventricular Drain (EVD) Placement Using a Hands-On Training Session on a Simple Three-Dimensional (3D) Model

“…The current landscape of neurosurgery requires that a trainee develop a great deal of precision, accuracy, and knowledge well before they ever pick up a scalpel. The EVD is most commonly one of the first procedures that junior residents learn, and then are given the ability to perform on their own without direct supervision [4,5]. Despite being one of the first invasive procedures learned, it presents with its own difficulties: it is a blind procedure without navigation, and the surgeon must rely on external landmarks and tactile feedback to approximate the ideal catheter trajectory and position.…”

“…Despite being one of the first invasive procedures learned, it presents with its own difficulties: it is a blind procedure without navigation, and the surgeon must rely on external landmarks and tactile feedback to approximate the ideal catheter trajectory and position. Complications of catheter misplacement can include worsening hydrocephalus, hemorrhage, infections, malfunctioning drains, need to replace the drain, or injury to surrounding cortical tissue [4,6]. These types of sequelae can lead to catastrophic outcomes, and trainees need to have confidence in both doing the procedure and complication management.…”

“…The external ventricular drain (EVD) procedure is among the first, and most basic, procedures to master as a junior neurosurgical resident [4,5]. It involves placing a silicon-based catheter into the ventricular system to provide a diversion for cerebrospinal fluid (CSF).…”

Simulation-based procedure training (SBPT) in rarely performed procedures: a blueprint for theory-informed design considerations

“…Despite this, higher fidelity simulation may be more appropriate for advanced learners to give an adequate level of psychological fidelity. Whilst there are many commercially available simulators, high- and low-fidelity simulators, particularly for procedural skills, can be created from readily accessible material, such as gelatine-based and 3D printing, at low cost [ 11 , 13 , 19 , 55 , 56 ].…”

Letter to the Editor: How is COVID-19 Going to Affect Education in Neurosurgery? A Step Toward a New Era of Educational Training

“…All these implementations made it extremely difficult for residents to master all the operative techniques in a limited time. 9 Further, legal accountability for medical services and patient safety monitoring has placed increased pressure on operational performance and outcomes. The restrictions imposed with social distancing and the availability and cost of cadavers for training also pose significant difficulties in the neurosurgical formation.…”