Miranpuri Amrendra S, Nickele Christopher M, Akture Erinc, Royalty Kevin, Niemann David B
Department of Neurologic Surgery, University of Wisconsin, Madison, Wisconsin, USA.
Department of Surgery, Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA.
J Neurointerv Surg. 2014 Sep;6(7):561-4. doi: 10.1136/neurintsurg-2013-010826. Epub 2013 Sep 23.
Simulation techniques in neurosurgical training are becoming more important. The purpose of this study was to determine whether silicone vascular models used in the angiography suite can render improvement in trainee performance and safety in neuroendovascular procedures.
10 residents from neurosurgery and radiology training programs were asked to perform a diagnostic angiogram on a silicone based vascular model (United Biologics, Tustin, USA). This was done in the angiography suite with the full biplane fluoroscopy machine (Siemens, Munich, Germany). On their first attempt, they were coached by a faculty member trained in endovascular neurosurgery; on their second attempt, they received coaching only if the procedure had stalled. Technique was scored on multiple criteria by the faculty, and total time and fluoroscopy time were recorded on both attempts.
In this group of 10 residents, overall procedure time significantly decreased from 51 to 42 min (p=0.01), and total fluoro time significantly decreased from 12 to 9 min (p=0.002) between the first attempt and the second attempt. Technical skill increased significantly in navigation, vessel selection, projection setup, and road map usage.
Silicone vascular models used in the angiography suite, with the clinical working tools and biplane fluoroscopy, provide a valuable experience for training residents in diagnostic angiography, and improved performance and safety.
神经外科手术培训中的模拟技术正变得越来越重要。本研究的目的是确定血管造影室中使用的硅胶血管模型是否能提高学员在神经血管内介入手术中的操作水平和安全性。
邀请了10名神经外科和放射科培训项目的住院医师在一个硅胶基血管模型（美国加利福尼亚州图斯廷市联合生物制品公司）上进行诊断性血管造影。这是在血管造影室使用全双平面荧光透视机（德国慕尼黑西门子公司）完成的。在他们第一次尝试时，由一名接受过血管内神经外科培训的教员进行指导；在他们第二次尝试时，只有在操作停滞不前时才会得到指导。教员根据多项标准对技术进行评分，并记录两次尝试的总时间和荧光透视时间。
在这10名住院医师中，第一次尝试和第二次尝试之间，总体操作时间从51分钟显著减少至42分钟（p = 0.01），总荧光透视时间从12分钟显著减少至9分钟（p = 0.002）。在导航、血管选择、投影设置和路线图使用方面，技术技能有显著提高。
血管造影室中使用的硅胶血管模型，结合临床工作工具和双平面荧光透视，为培训住院医师进行诊断性血管造影提供了宝贵的经验，并提高了操作水平和安全性。
