Neurosurgical simulator for training aneurysm microsurgery—a user suitability study involving neurosurgeons and residents

Abstract

Background Due to its complexity and to existing treatment alternatives, exposure to intracranial aneurysm microsurgery at the time of neurosurgical residency is limited. The current state of the art includes training methods like assisting in surgeries, operating under supervision, and video training. These approaches are labor-intensive and difficult to fit into a timetable limited by the new work regulations. Existing virtual reality (VR)–based training modules lack patient-specific exercises and haptic properties and are thus inferior to hands-on training sessions and exposure to real surgical procedures. Materials and methods We developed a physical simulator able to reproduce the experience of clipping an intracranial aneurysm based on a patient-specific 3D-printed model of the skull, brain, and arteries. The simulator is made of materials that not only imitate tissue properties including arterial wall patency, thickness, and elasticity but also able to recreate a pulsatile blood flow. A sample group of 25 neurosurgeons and residents (n = 16: early residency with less than 4 years of neurosurgical exposure; n = 9: late residency and board-certified neurosurgeons, 4–15 years of neurosurgical exposure) took part to the study. Participants evaluated the simulator and were asked to answer questions about surgical simulation anatomy, realism, haptics, tactility, and general usage, scored on a 5-point Likert scale. In order to evaluate the feasibility of a future validation study on the role of the simulator in neurosurgical postgraduate training, an expert neurosurgeon assessed participants’ clipping performance and a comparison between groups was done. Results The proposed simulator is reliable and potentially useful for training neurosurgical residents and board-certified neurosurgeons. A large majority of participants (84%) found it a better alternative than conventional neurosurgical training methods. Conclusion The integration of a new surgical simulator including blood circulation and pulsatility should be considered as part of the future armamentarium of postgraduate education aimed to ensure high training standards for current and future generations of neurosurgeons involved in intracranial aneurysm surgery.

Virtual-Augmented Reality and Life-Like Neurosurgical Simulator for Training: First Evaluation of a Hands-On Experience for Residents

“…Joseph et al ( 19 ) developed and used a physical simulator that was able to reproduce the experience of clipping intracranial aneurysms based on 3D-printed models of skull, brain, and arteries. They judged this simulator as a reliable and useful tool for neurosurgical training.…”

Presurgical selection of the ideal aneurysm clip by the use of a three-dimensional planning system

“…A further approach to presurgical clipping simulation taking aneurysm deformation into account is the use of 3D-printed aneurysm models prior to surgery [35][36][37][38][39][40][41][42][43][44]. These printed models represent an attempt to simulate aneurysm clipping with increasing complexity, adding blood flow simulation and aneurysm pulsation in some studies.…”

Establishing a point-of-care additive manufacturing workflow for clinical use

“…Utilizing 3-D printing, they limited the error of true vascular wall thickness by 2–5%, and were within about 5% of matching the true characteristics of the surrounding blood vessels [ 71 ]. This positive feedback was echoed in another study examining neurosurgical aneurysm clipping simulation; the majority of participants (84%) noted that training with the use of a 3-D model was a better alternative than the traditional training methods [ 69 ]. Taking advantage of realistic 3-D models is not limited to neurosurgery and is becoming more extensively exploited in other fields.…”