Podkovik Stacey, Patchana Tye, Farr Saman, Brazdzionis James, Marino Max, Savla Paras, Kashyap Samir, Chin Brian, Crouch Andrew, Miulli Dan E
Department of Neurological Surgery, Riverside University Health System Medical Center, Riverside, USA.
Department of Neurological Surgery, Riverside University Health System Medical Center, Moreno Valley, USA.
Cureus. 2022 Aug 14;14(8):e28014. doi: 10.7759/cureus.28014. eCollection 2022 Aug.
Neurosurgery is a demanding field with small margins of error within the operative field. Small errors can yield devastating consequences. Simulation has been proposed as a methodology for improving surgical skills within the neurosurgical realm. This study was conducted to investigate a novel realistic design for a clinical simulation based, low-cost alternative of external ventricular drain (EVD) placement, an essential basic neurosurgical procedure that is necessary for clinicians to master. A low-cost three-dimensional (3D) printed head using thermoplastic polylactic acid was designed with the tactile feedback of outer table, cancellous bone, and inner tables for drilling with replaceable frontal bones pieces for multi-use purposes. An agar gel filled with water was designed to simulate tactile passage through the cortex and into the ventricles. Neurosurgical and emergency resident physicians participated in a didactic session and then attempted placement of an EVD using the model to gauge the simulated model for accuracy and realism. Positioning, procedural time, and realism was evaluated. Improvements in procedural time and positioning were identified for both neurosurgical and emergency medicine (EM) residents. Catheter placement was within ideal position for all participants by the third attempt. All residents stated they felt more comfortable with placement with subsequent attempts. Neurosurgical residents subjectively noted similarities in tactile feedback during drilling compared to in-vivo. A low-cost realistic 3D printed model simulating basic neurosurgical procedures demonstrated improved procedural times and precision with neurosurgical and EM residents. Further, similarities between in-vivo tactile feedback and the low-cost simulation technology was noted. This low cost-model may be used as an adjunct for teaching to promote early procedural competency in neurosurgical techniques to promote learning without predisposition to patient morbidity.
神经外科是一个要求严苛的领域，手术操作容错率极小。小失误可能会带来灾难性后果。模拟已被提议作为一种提高神经外科领域手术技能的方法。本研究旨在探讨一种新颖的、基于临床模拟的低成本外部脑室引流（EVD）放置替代方案，这是一项临床医生必须掌握的基本神经外科手术。使用热塑性聚乳酸设计了一种低成本的三维（3D）打印头部，具有外板、松质骨和内板的触觉反馈，用于钻孔，并带有可更换的额骨片以便多次使用。设计了一种装满水的琼脂凝胶来模拟通过皮质进入脑室的触觉过程。神经外科和急诊住院医师参加了一次教学课程，然后使用该模型尝试放置EVD，以评估模拟模型的准确性和真实感。对定位、操作时间和真实感进行了评估。神经外科和急诊医学（EM）住院医师在操作时间和定位方面均有改善。到第三次尝试时，所有参与者的导管放置位置均在理想范围内。所有住院医师均表示，后续尝试放置时他们感觉更自如。神经外科住院医师主观上指出，钻孔时的触觉反馈与体内情况相似。一个模拟基本神经外科手术的低成本逼真3D打印模型，在神经外科和EM住院医师中显示出操作时间缩短和精度提高。此外，还注意到了体内触觉反馈与低成本模拟技术之间的相似性。这种低成本模型可作为教学辅助工具，以促进神经外科技术早期操作能力的提升，促进学习，同时避免患者发病风险。
