Müns Andrea, Meixensberger Jürgen, Lindner Dirk
Department of Neurosurgery, University Hospital Leipzig, Saxony, Germany.
Department of Neurosurgery, University Hospital Leipzig, Saxony, Germany ; Innovation Center, Computer Assisted Surgery, University Leipzig, Saxony, Germany.
Surg Neurol Int. 2014 Dec 6;5:173. doi: 10.4103/2152-7806.146346. eCollection 2014.
The complexity of neurosurgical interventions demands innovative training solutions and standardized evaluation methods that in recent times have been the object of increased research interest. The objective is to establish an education curriculum on a phantom-based training system incorporating theoretical and practical components for important aspects of brain tumor surgery.
Training covers surgical planning of the optimal access path based on real patient data, setup of the navigation system including phantom registration and navigated craniotomy with real instruments. Nine residents from different education levels carried out three simulations on different data sets with varying tumor locations. Trainings were evaluated by a specialist using a uniform score system assessing tumor identification, registration accuracy, injured structures, planning and execution accuracy, tumor accessibility and required time.
Average scores improved from 16.9 to 20.4 between first and third training. Average time to craniotomy improved from 28.97 to 21.07 min, average time to suture improved from 37.83 to 27.47 min. Significant correlations were found between time to craniotomy and number of training (P < 0.05), between time to suture and number of training (P < 0.05) as well as between score and number of training (P < 0.01).
The training system is evaluated to be a suitable training tool for residents to become familiar with the complex procedures of autonomous neurosurgical planning and conducting of craniotomies in tumor surgeries. Becoming more confident is supposed to result in less error-prone and faster operation procedures and thus is a benefit for both physicians and patients.
神经外科手术干预的复杂性需要创新的培训解决方案和标准化的评估方法，近年来这些一直是研究兴趣增加的对象。目的是在基于体模的培训系统上建立一个教育课程，该系统纳入脑肿瘤手术重要方面的理论和实践内容。
培训内容包括基于真实患者数据的最佳入路手术规划、导航系统的设置（包括体模配准）以及使用真实器械进行导航开颅手术。九名来自不同教育水平的住院医师在不同数据集上对不同肿瘤位置进行了三次模拟。由一名专家使用统一评分系统对培训进行评估，该系统评估肿瘤识别、配准准确性、受损结构、规划和执行准确性、肿瘤可及性以及所需时间。
第一次培训到第三次培训的平均分数从16.9提高到20.4。开颅平均时间从28.97分钟提高到21.07分钟，缝合平均时间从37.83分钟提高到27.47分钟。发现开颅时间与培训次数之间存在显著相关性（P < 0.05），缝合时间与培训次数之间存在显著相关性（P < 0.05），以及分数与培训次数之间存在显著相关性（P < 0.01）。
该培训系统被评估为一种适合住院医师的培训工具，可使其熟悉肿瘤手术中自主神经外科规划和开颅手术的复杂程序。变得更加自信应该会减少操作程序中的错误并加快速度，从而对医生和患者都有益。
