1Department of Neurosurgery, University Hospital of Basel.
2Division of Pediatric Neurosurgery, Children's University Hospital of Basel.
Neurosurg Focus. 2020 Mar 1;48(3):E18. doi: 10.3171/2019.12.FOCUS19841.
Neuroendoscopic surgery using an ultrasonic aspirator represents a valid tool with which to perform the safe resection of deep-seated ventricular lesions, but the handling of neuroendoscopic instruments is technically challenging, requiring extensive training to achieve a steep learning curve. Simulation-based methods are increasingly used to improve surgical skills, allowing neurosurgical trainees to practice in a risk-free, reproducible environment. The authors introduce a synthetic, patient-specific simulator that enables trainees to develop skills for endoscopic ventricular tumor removal, and they evaluate the model's validity as a training instrument with regard to realism, mechanical proprieties, procedural content, and handling.
The authors developed a synthetic simulator based on a patient-specific CT data set. The anatomical features were segmented, and several realistic 1:1 skull models with all relevant ventricular structures were fabricated by a 3D printer. Vascular structures and the choroid plexus were included. A tumor model, composed of polyvinyl alcohol, mimicking a soft-consistency lesion, was secured in different spots of the frontal horn and within the third ventricle. Neurosurgical trainees participating in a neuroendoscopic workshop qualitatively assessed, by means of a feedback survey, the properties of the simulator as a training model that teaches neuroendoscopic ultrasonic ventricular tumor surgery; the trainees rated 10 items according to a 5-point Likert scale.
Participants appreciated the model as a valid hands-on training tool for neuroendoscopic ultrasonic aspirator tumor removal, highly rating the procedural content. Furthermore, they mostly agreed on its comparably realistic anatomical and mechanical properties. By the model's first application, the authors were able to recognize possible improvement measures, such as the development of different tumor model textures and the possibility, for the user, of creating a realistic surgical skull approach and neuroendoscopic trajectory.
A low-cost, patient-specific, reusable 3D-printed simulator for the training of neuroendoscopic ultrasonic aspirator tumor removal was successfully developed. The simulator is a useful tool for teaching neuroendoscopic techniques and provides support in the development of the required surgical skills.
使用超声吸引器的神经内镜手术是一种安全切除深部脑室病变的有效工具，但神经内镜器械的操作具有一定技术难度，需要经过广泛的培训才能达到陡峭的学习曲线。基于模拟的方法越来越多地用于提高手术技能，使神经外科受训者能够在无风险、可重复的环境中进行练习。作者介绍了一种基于患者特定 CT 数据集的合成、患者特异性模拟器，使受训者能够开发出用于内镜脑室肿瘤切除的技能，并评估了该模型作为一种培训工具在真实性、机械特性、程序内容和操作方面的有效性。
作者基于患者特定的 CT 数据集开发了一种合成模拟器。对解剖特征进行了分割，并通过 3D 打印机制作了几个具有所有相关脑室结构的逼真 1:1 颅骨模型。包括血管结构和脉络丛。一个由聚乙烯醇组成的肿瘤模型，模拟了一个软质地病变，被固定在前角和第三脑室的不同部位。参加神经内镜研讨会的神经外科受训者通过反馈调查，定性评估了模拟器作为教授神经内镜超声脑室肿瘤手术的培训模型的特性；受训者根据 5 分制 Likert 量表对 10 个项目进行了评分。
参与者认为该模型是神经内镜超声吸引器肿瘤切除的有效实践培训工具，对程序内容给予高度评价。此外，他们大多同意该模型具有相当真实的解剖和机械特性。通过模型的首次应用，作者能够识别出可能的改进措施，例如开发不同的肿瘤模型纹理，以及用户创建真实手术颅骨入路和神经内镜轨迹的可能性。
作者成功开发了一种用于神经内镜超声吸引器肿瘤切除培训的低成本、患者特异性、可重复使用的 3D 打印模拟器。该模拟器是教授神经内镜技术的有用工具，并为发展所需的手术技能提供支持。
