Coelho G, Kondageski C, Vaz-Guimarães Filho F, Ramina R, Hunhevicz S C, Daga F, Lyra M R, Cavalheiro S, Zymberg S T
Department of Neurosurgery , Neurologia Institute of Curitiba , Curitiba PR , Brazil. g
Minim Invasive Neurosurg. 2011 Jun;54(3):115-8. doi: 10.1055/s-0031-1283170. Epub 2011 Aug 23.
Over the last decade, neuroendoscopy has re-emerged as an interesting option in the management of intraventricular lesions in both children and adults. Nonetheless, as it has become more difficult to use cadaveric specimens in training, the development of alternative methods was vital. The aim of this study was to analyze the performance of a real simulator, in association with image-guided navigation, as a teaching tool for the training of intraventricular endoscopic procedures.
3 real simulators were built using a special type of resin. 1 was designed to represent the abnormally enlarged ventricles, making it possible for a third ventriculostomy to be performed. The remaining 2 were designed to simulate a person's skull and brain bearing intraventricular lesions, which were placed as follows: in the foramen of Monro region, in the frontal and occipital horns of the lateral ventricles and within the third ventricle. In all models, MRI images were obtained for navigation guidance. Within the ventricles, the relevant anatomic structures and the lesions were identified through the endoscope and compared with the position given by the navigation device. The next step consisted of manipulating the lesions, using standard endoscopic techniques.
We observed that the models were MRI compatible, easy and safe to handle. They nicely reproduced the intraventricular anatomy and brain consistence, as well as simulated intraventricular lesions. The image-based navigation was efficient in guiding the surgeon through the endoscopic procedure, allowing the selection of the best approach as well as defining the relevant surgical landmarks for each ventricular compartment. Nonetheless, as expected, navigation inaccuracies occurred. After the training sessions the surgeons felt they had gained valued experience by dealing with intraventricular lesions employing endoscopic techniques.
The use of real simulators in association with image-guided navigation proved to be an effective tool in training for neuroendoscopy.
在过去十年中，神经内镜已再度成为儿童和成人脑室内病变管理中一种引人关注的选择。然而，由于在培训中使用尸体标本变得愈发困难，开发替代方法至关重要。本研究的目的是分析一种真实模拟器与图像引导导航相结合作为脑室内内镜手术培训教学工具的性能。
使用一种特殊类型的树脂制作了3个真实模拟器。1个被设计成代表异常扩大的脑室，以便能够进行第三脑室造瘘术。其余2个被设计成模拟带有脑室内病变的人头颅骨和大脑，病变放置如下：在室间孔区域、侧脑室的额角和枕角以及第三脑室内。在所有模型中，获取MRI图像用于导航引导。在脑室内，通过内镜识别相关解剖结构和病变，并与导航设备给出的位置进行比较。下一步是使用标准内镜技术处理病变。
我们观察到这些模型与MRI兼容，操作简便且安全。它们很好地再现了脑室内解剖结构和脑质地，以及模拟的脑室内病变。基于图像的导航在引导外科医生进行内镜手术方面很有效，允许选择最佳入路以及为每个脑室腔确定相关手术标志。尽管如此，正如预期的那样，出现了导航不准确的情况。培训课程结束后，外科医生感觉他们通过使用内镜技术处理脑室内病变获得了宝贵的经验。
事实证明，真实模拟器与图像引导导航相结合是神经内镜培训的一种有效工具。
