Coelho Giselle, Figueiredo Eberval Gadelha, Rabelo Nícollas Nunes, Teixeira Manoel Jacobsen, Zanon Nelci
1Pediatric Neurosurgery, Department of Neurosurgery, Santa Marcelina Hospital.
2Department of Neurosurgery, University of São Paulo.
J Neurosurg Pediatr. 2019 Aug 2;24(4):423-432. doi: 10.3171/2019.2.PEDS18597. Print 2019 Oct 1.
Craniosynostosis is a premature cranial suture junction and requires a craniectomy to decrease cranial compression and remodel the affected areas of the skull. However, mastering these neurosurgical procedures requires many years of supervised training. The use of surgical simulation can reduce the risk of intraoperative error. The authors propose a new instrument for neurosurgical education, which mixes reality with virtual and realistic simulation for repair of craniosynostosis (scaphocephaly type).
This study tested reality simulators with a synthetic thermo-retractile/thermosensitive rubber joined with different polymers. To validate the model, 18 experienced surgeons participated in this study using 3D videos developed using 3DS Max software. Renier's "H" technique for craniosynostosis correction was applied during the simulation. All participants completed questionnaires to evaluate the simulator.
An expert surgical team approved the craniosynostosis reality and virtual simulators. More than 94% of participants found the simulator relevant, considering aspects such as weight, surgical positioning, dissection by planes, and cranial reconstruction. The consistency and material resistance were also approved on average by more than 60% of the surgeons.
The virtual simulator demands a high degree of effectiveness with 3D perception in anatomy and operative strategies in neurosurgical training. Physical and virtual simulation with mixed reality required psychomotor and cognitive abilities otherwise acquired only during practical surgical training with supervision.
颅缝早闭是一种颅骨缝线过早融合的疾病，需要进行颅骨切除术以减轻颅骨压迫并重塑颅骨的受影响区域。然而，掌握这些神经外科手术需要多年的带教培训。手术模拟的应用可以降低术中出错的风险。作者提出了一种用于神经外科教育的新器械，它将现实与虚拟及逼真模拟相结合，用于修复颅缝早闭（舟状头型）。
本研究使用与不同聚合物结合的合成热缩/热敏橡胶测试了实物模拟器。为验证该模型，18名经验丰富的外科医生参与了本研究，使用的是用3DS Max软件制作的3D视频。在模拟过程中应用了雷尼尔氏“ H”技术进行颅缝早闭矫正。所有参与者都填写了问卷以评估模拟器。
一个专家手术团队认可了颅缝早闭实物模拟器和虚拟模拟器。超过94%的参与者认为该模拟器具有相关性，涉及重量、手术体位、按层面进行解剖以及颅骨重建等方面。超过60%的外科医生平均也认可了其一致性和材料耐受性。
在神经外科培训中，虚拟模拟器在解剖学和手术策略的三维感知方面需要具备高度有效性。混合现实的实物和虚拟模拟需要心理运动和认知能力，而这些能力原本只能在有带教的实际手术培训中获得。
