Müns Andrea, Mühl Constanze, Haase Robert, Möckel Hendrik, Chalopin Claire, Meixensberger Jürgen, Lindner Dirk
Department of Neurosurgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany,
Acta Neurochir (Wien). 2014 Jun;156(6):1237-43. doi: 10.1007/s00701-013-1918-3. Epub 2013 Oct 23.
Brain tumor surgeries are associated with a high technical and personal effort. The required interactions between the surgeon and the technical components, such as neuronavigation, surgical instruments and intraoperative imaging, are complex and demand innovative training solutions and standardized evaluation methods. Phantom-based training systems could be useful in complementing the existing surgical education and training.
A prototype of a phantom-based training system was developed, intended for standardized training of important aspects of brain tumor surgery based on real patient data. The head phantom consists of a three-part construction that includes a reusable base and adapter, as well as a changeable module for single use. Training covers surgical planning of the optimal access path, the setup of the navigation system including the registration of the head phantom, as well as the navigated craniotomy with real instruments. Tracked instruments during the simulation and predefined access paths constitute the basis for the essential objective training feedback.
The prototype was evaluated in a pilot study by assistant physicians at different education levels. They performed a complete simulation and a final assessment using an evaluation questionnaire. The analysis of the questionnaire showed the evaluation result as "good" for the phantom construction and the used materials. The learning effect concerning the navigated planning was evaluated as "very good", as well as having the effect of increasing safety for the surgeon before planning and conducting craniotomies independently on patients.
The training system represents a promising approach for the future training of neurosurgeons. It aims to improve surgical skill training by creating a more realistic simulation in a non-risk environment. Hence, it could help to bridge the gap between theoretical and practical training with the potential to benefit both physicians and patients.
脑肿瘤手术需要高度的技术投入和人力投入。外科医生与技术组件（如神经导航、手术器械和术中成像）之间所需的交互非常复杂，需要创新的培训解决方案和标准化的评估方法。基于模型的训练系统可能有助于补充现有的外科教育和培训。
开发了一种基于模型的训练系统原型，旨在基于真实患者数据对脑肿瘤手术的重要方面进行标准化培训。头部模型由三部分组成，包括一个可重复使用的底座和适配器，以及一个一次性使用的可变模块。培训内容包括最佳入路路径的手术规划、导航系统的设置（包括头部模型的配准）以及使用真实器械进行导航开颅手术。模拟过程中的跟踪器械和预定义的入路路径构成了基本客观训练反馈的基础。
该原型在一项试点研究中由不同教育水平的助理医师进行评估。他们使用评估问卷进行了完整的模拟和最终评估。问卷分析显示，对模型结构和所用材料的评估结果为“良好”。关于导航规划的学习效果被评估为“非常好”，并且在外科医生独立对患者进行手术规划和开颅手术之前，具有提高其安全性的作用。
该训练系统是未来神经外科医生培训的一种有前景的方法。它旨在通过在无风险环境中创建更真实的模拟来改善手术技能培训。因此，它有助于弥合理论培训和实践培训之间的差距，有可能使医生和患者都受益。
