Mixed-Reality Simulation for Neurosurgical Procedures

Bova, Frank J.; Rajon, Didier A.; Friedman, William A.; Murad, Gregory J. A.; Hoh, Daniel J.; Jacob, Roshan; Lampotang, Samsun; Lizdas, David; Lombard, Gwen; Lister, J.

doi:10.1227/neu.0000000000000113

Cited by 50 publications

(33 citation statements)

References 8 publications

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“…Eleven survey items were targeted to measure the opinions of experienced surgeons regarding simulator characteristics and features across 5 domains: physical attributes, realism of experience, value of simulator, relevance to clinical practice, and a global (overall) rating. The preliminary validation process aligned with best practices defined by the current standards framework offered by the American Educational Research Association, American Psychological Association, and National Council on Measurement in Education, 3 while the metrics captured were supported by current literature. 1,13 Statistical analyses were performed using a many-facet Rasch model 2,10 to compute average ratings and analyze rating differences across levels of training and training program sites.…”

Section: Evaluation Of Content Validitymentioning

confidence: 96%

A physical simulator for endoscopic endonasal drilling techniques: technical note

Tai

Wang

Joseph

et al. 2016

JNS

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J Neurosurg 124:811-816, 2016P atients suffering from pathologies of the ventral and ventrolateral skull base often require surgical intervention. Access to the skull base traditionally required extensive tissue manipulation, but recent advances in endoscopic techniques have allowed access to the skull base using less destructive techniques via the nostril as a natural corridor. The endoscopic endonasal approach (EEA) is employed in the treatment of pituitary adenomas, Rathke's cleft cysts, ventral cranial base meningiomas, craniopharyngiomas, chordomas, olfactory neuroblastomas, and sinonasal carcinomas involving the skull base, among other pathologies. Exposure and resection often require drilling of bone adjacent to critical neurovascular structures. Cranial nerve damage can result in catastrophic disability, and vascular injury may be maiming or fatal. 6 Although residents are trained to perform the EEA by participating in operations on patients while under close supervision, critical drilling is often still done by the attending surgeon. Endoscopic endonasal drilling is somewhat unique in regard to the instruments used, the long reach required, and the restricted angulation. Cadaver training is a viable option for teaching such skills, when available. Sensory feedback from cadaver bone remains largely unchanged from live tissue, and the anatomy remains intact. However, cadavers are expensive and require specialized equipment, staff, and facilities. Availability of specimens or facilities, in most cases, precludes the use of cadavers for basic technique training; rather, their value is maximized when used by more experienced operators. Alternatively, a number of virtual reality (VR) simulators are available for EEA, but they often lack realistic drilling haptics, and the initial costs could be high. 2,10We successfully developed a physical simulator for ventriculostomy placement and demonstrated its validity. 15 Based on that experience, we also sought to create an inexpensive, high-fidelity simulator by which the drilling aspects of the EEA could be practiced by trainees once they advance to the point of surgical participation, thereby reducing the risk to patients. This endeavor, a collaborative effort of neurosurgeons, otolaryngologists, engineers, and an education/research specialist, is described in terms of simulator design, training setup, and validation process. In this paper, the authors present a physical model developed to teach surgeons the requisite drilling techniques when using an endoscopic endonasal approach (EEA) to the skull base. EEA is increasingly used for treating pathologies of the ventral and ventrolateral cranial base. Endonasal drilling is a unique skill in terms of the instruments used, the long reach required, and the restricted angulation, and gaining competency requires much practice. Based on the successful experience in creating custom simulators, the authors used 3D printing to build an EEA training model from post-processed thin-cut head CT scans, formulating the materials ...

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Section: Evaluation Of Content Validitymentioning

confidence: 96%

A physical simulator for endoscopic endonasal drilling techniques: technical note

Tai

Wang

Joseph

et al. 2016

JNS

View full text Add to dashboard Cite

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“…A full-scale, stereoscopic understanding of the pathology allows for more detailed planning and simulation of the procedure (10)(11)(12)(13)(14)(15)(16)(17)(18)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(50)(51)(52). Assessing complex pathologies on a model overcomes many of the issues associated with traditional 3D imaging, such as the lack of realistic anatomical representation and the associated complexity of computer-related skills and techniques (10,12).…”

Section: Surgical Planningmentioning

confidence: 99%

Systematic review of 3D printing in spinal surgery: the current state of play

et al. 2017

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Three-dimensional printing (3DP), also known as "Additive Manufacturing", is a rapidly growing industry, particularly in the area of spinal surgery. Given the complex anatomy of the spine and delicate nature of surrounding structures, 3DP has the potential to aid surgical planning and procedural accuracy. We perform a systematic review of current literature on the applications of 3DP in spinal surgery. Six electronic databases were searched for original published studies reporting cases or outcomes for 3DP surgical models, guides or implants for spinal surgery. The findings of these studies were synthesized and summarized. These searches returned a combined 2,411 articles. Of these, 54 were included in this review. 3DP is currently used for surgical planning, intra-operative surgical guides, customised prostheses as well as "Off-the-Shelf" implants. The technology has the potential for enhanced implant properties, as well as decreased surgical time and better patient outcomes. The majority of the data thus far is from low-quality studies with inherent biases linked with the excitement of a new field. As the body of literature continues to expand, larger scale studies to evaluate advantages and disadvantages, and longer-term follow up will enhance our knowledge of the effect 3DP has in spinal surgery. In addition, issues such as financial impact, time to design and print, materials selection and bio-printing will evolve as this rapidly expanding field matures.

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“…Desde as primeiras escolas médicas, exigiu-se dos estudantes e residentes que pratiquem a dissecação em cadáveres, não apenas para aprenderem anatomia, mas também para estarem familiarizados com os instrumentos básicos e seus usos apropriados [9,15,16]. Posteriormente, o treinamento com animais anestesiados possibilitou outros procedimentos, tais como grandes intervenções cirúrgicas (esplenectomia, nefrectomia e ressecções de intestino) e treinamento de situações de emergência, como hemorragias [9,16].…”

Section: Métodos De Treinamentounclassified

“…Posteriormente, o treinamento com animais anestesiados possibilitou outros procedimentos, tais como grandes intervenções cirúrgicas (esplenectomia, nefrectomia e ressecções de intestino) e treinamento de situações de emergência, como hemorragias [9,16].…”

Section: Métodos De Treinamentounclassified

História da simulação cirúrgica e sua aplicação em Neurocirurgia

Coelho¹,

Vieira²

2018

Sci Med

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Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. ABSTRACT OBJECTIVES: In this article, the authors address the historical evolution of surgical simulation, focusing on its application in Neurosurgery. METHODS: Literature search was done in the PubMed/Medline and Scopus databases, using the terms "history AND simulation"; and "simulation AND neurosurgery". There was no limit for the publication date. RESULTS: We selected 30 articles whose contents included data of interest for the objective of the study. Simulation has been used for centuries in a variety of ways, including the dissection of corpses by the early physicians (such as Galeno) and military training (for example in war games). Anatomical models were created in the eighteenth century and continued to improve in the following centuries. Virtual reality simulation was first used in 1987 and became popular in the early 1990s. Subsequently, synthetic anatomical models were created that reproduce surgical scenarios close to the real one, with great applicability today. CONCLUSIONS: This literature review highlighted evolutionary aspects of simulation and its current application in medical education. Innovations in this field were highly appreciated by members of the neurosurgical community who recognized the vast potential of simulation to revolutionize this specialty, where intraoperative errors can have disastrous consequences. This historical review may contribute to a better understanding of the relevant role of simulation and for its implementation in the medical curriculum, especially in high complexity specialties such as Neurosurgery.

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Mixed-Reality Simulation for Neurosurgical Procedures

Cited by 50 publications

References 8 publications

A physical simulator for endoscopic endonasal drilling techniques: technical note

A physical simulator for endoscopic endonasal drilling techniques: technical note

Systematic review of 3D printing in spinal surgery: the current state of play

História da simulação cirúrgica e sua aplicação em Neurocirurgia

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