Introducing a Realistic, Low-Cost Simulation Model for Clipping of Brain Aneurysms

Gallardo, Federico; Feldman, Santiago; Garcia, Aylen Andrea Targa; Morales, Nadia Sabrina; Martínez, Silvina; Martin, Carol; Bottan, Juan Santiago; Orellana, Cristian Marcelo; Almerares, Leandro Noel; Rubino, Pablo

doi:10.1016/j.wneu.2021.11.012

Cited by 5 publications

(4 citation statements)

References 37 publications

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“…1 , 26 articles met the inclusion criteria. Two studies were added to the category “ex vivo: cadavers” [ 13 , 14 ], one study was added to “ex vivo: human placenta” [ 15 ], and three studies were added to “ex vivo: chicken wings” [ 16 - 18 ]. “Virtual reality” contained 11 studies [ 19 - 29 ], “3D static simulators” had six [ 30 - 35 ], and “3D dynamic simulators” had three [ 9 , 36 , 37 ].…”

Section: Resultsmentioning

confidence: 99%

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Simulation training approaches in intracranial aneurysm surgery—a systematic review

2023

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Background With the increasing complexity and decreasing exposure to intracranial aneurysm surgery, training and maintenance of the surgical skills have become challenging. This review elaborated on simulation training for intracranial aneurysm clipping. Methods A systematic review was performed according to the PRISMA guidelines to identify studies on aneurysm clipping training using models and simulators. The primary outcome was the identification of the predominant modes of the simulation process, models, and training methods associated with a microsurgical learning curve. The secondary outcomes included assessments of the validation of such simulators and the learning capability from the use of such simulators. Results Of the 2068 articles screened, 26 studies met the inclusion criteria. The chosen reports used a wide range of simulation approaches including ex vivo methods (n = 6); virtual reality (VR) platforms (n = 11); and static (n = 6) and dynamic (n = 3) 3D-printed aneurysm models (n = 6). The ex vivo training methods have limited availability, VR simulators lack haptics and tactility, while 3D static models lack important microanatomical components and the simulation of blood flow. 3D dynamic models including pulsatile flow are reusable and cost-effective but miss microanatomical components. Conclusions The existing training methods are heterogenous and do not realistically simulate the complete microsurgical workflow. The current simulations lack certain anatomical features and crucial surgical steps. Future research should focus on developing and validating a reusable, cost-effective training platform. No systematic validation method exists for the different training models, so there is a need to build homogenous assessment tools and validate the role of simulation in education and patient safety.

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Section: Resultsmentioning

confidence: 99%

“…Artificial aneurysms were created based on human placental vasculature, chicken wing or thigh vessels, or venous grafts from cadavers’ necks. Carlos et al (2022) [ 16 ] introduced artificial aneurysms into bovine brains, while Aboud et al (2015) [ 14 ] introduced them into 23 living cadavers between 2009 and 2014.…”

Section: Resultsmentioning

confidence: 99%

Simulation training approaches in intracranial aneurysm surgery—a systematic review

2023

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“…7 However, the availability of such simulators on the market is limited. While many previous studies have focused on face, content, and predictive validity, [21][22][23][24][25][26] more research is needed to investigate their impact on the learning curve for IA treatment.…”

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confidence: 99%

Training Performance Assessment for Intracranial Aneurysm Clipping Surgery Using a Patient-Specific Mixed-Reality Simulator: A Learning Curve Study

Cuba,

Vanluchene,

Murek

et al. 2024

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: The value of simulation-based training in medicine and surgery has been widely demonstrated. This study investigates the introduction and use of a new mixed-reality neurosurgical simulator in aneurysm clipping surgery, focusing on the learning curve and performance improvement. METHODS: Five true-scale craniotomy head models replicating patient-specific neuroanatomy, along with a mixed-reality simulator, a neurosurgical microscope, and a set of microsurgical instruments and clips, were used in the operation theater to simulate aneurysm microsurgery. Six neurosurgical residents participated in five video-recorded simulation sessions over 4 months. Complementary learning modalities were implemented between sessions. Thereafter, three blinded analysts reported on residents' use of the microscope, quality of manipulation, aneurysm occlusion, clipping techniques, and aneurysm rupture. Data were also captured regarding training time and clipping attempts. RESULTS: Over the course of training, clipping time and number of clipping attempts decreased significantly (P = .018, P = .032) and the microscopic skills improved (P = .027). Quality of manipulation and aneurysm occlusion scoring improved initially although the trend was interrupted because the spacing between sessions increased. Significant differences in clipping time and attempts were observed between the most and least challenging patient models (P = .005, P = .0125). The least challenging models presented higher rates of occlusion based on indocyanine green angiography evaluation from the simulator. CONCLUSION: The intracranial aneurysm clipping learning curve can be improved by implementing a new mixed-reality simulator in dedicated training programs. The simulator and the models enable comprehensive training under the guidance of a mentor.

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“…Recently developed three-dimensional (3D) print models may be promising solutions to the global shortage of cadavers [13]. In particular, disease-specific models such as those with cerebral aneurysms and brain tumours are becoming more accurate and are promising methods for preoperative simulation from a realistic perspective [1,10,11,22]. However, due to the difficult construction of materials, some prototypes lacked brain tissue, and some used animal brain tissue [4,23].…”

mentioning

confidence: 99%

Obstacles to cadaver use for the development of neurosurgical techniques and devices in Japan

et al. 2022

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Introducing a Realistic, Low-Cost Simulation Model for Clipping of Brain Aneurysms

Cited by 5 publications

References 37 publications

Simulation training approaches in intracranial aneurysm surgery—a systematic review

Simulation training approaches in intracranial aneurysm surgery—a systematic review

Training Performance Assessment for Intracranial Aneurysm Clipping Surgery Using a Patient-Specific Mixed-Reality Simulator: A Learning Curve Study

Obstacles to cadaver use for the development of neurosurgical techniques and devices in Japan

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