Lai Marco, Skyrman Simon, Kor Flip, Homan Robert, El-Hajj Victor Gabriel, Babic Drazenko, Edström Erik, Elmi-Terander Adrian, Hendriks Benno H W, de With Peter H N
Philips Research, High Tech Campus 34, 5656 Eindhoven, The Netherlands.
Department of Engineering, Eindhoven University of Technology (TU/e), 5612 Eindhoven, The Netherlands.
Bioengineering (Basel). 2022 Oct 9;9(10):537. doi: 10.3390/bioengineering9100537.
Neurosurgical procedures are complex and require years of training and experience. Traditional training on human cadavers is expensive, requires facilities and planning, and raises ethical concerns. Therefore, the use of anthropomorphic phantoms could be an excellent substitute. The aim of the study was to design and develop a patient-specific 3D-skull and brain model with realistic CT-attenuation suitable for conventional and augmented reality (AR)-navigated neurosurgical simulations.
The radiodensity of materials considered for the skull and brain phantoms were investigated using cone beam CT (CBCT) and compared to the radiodensities of the human skull and brain. The mechanical properties of the materials considered were tested in the laboratory and subsequently evaluated by clinically active neurosurgeons. Optimization of the phantom for the intended purposes was performed in a feedback cycle of tests and improvements.
The skull, including a complete representation of the nasal cavity and skull base, was 3D printed using polylactic acid with calcium carbonate. The brain was cast using a mixture of water and coolant, with 4 wt% polyvinyl alcohol and 0.1 wt% barium sulfate, in a mold obtained from segmentation of CBCT and T1 weighted MR images from a cadaver. The experiments revealed that the radiodensities of the skull and brain phantoms were 547 and 38 Hounsfield units (HU), as compared to real skull bone and brain tissues with values of around 1300 and 30 HU, respectively. As for the mechanical properties testing, the brain phantom exhibited a similar elasticity to real brain tissue. The phantom was subsequently evaluated by neurosurgeons in simulations of endonasal skull-base surgery, brain biopsies, and external ventricular drain (EVD) placement and found to fulfill the requirements of a surgical phantom.
A realistic and CT-compatible anthropomorphic head phantom was designed and successfully used for simulated augmented reality-led neurosurgical procedures. The anatomic details of the skull base and brain were realistically reproduced. This phantom can easily be manufactured and used for surgical training at a low cost.
神经外科手术复杂，需要多年的培训和经验。传统的人体尸体培训成本高昂，需要设施和规划，且引发伦理问题。因此，使用拟人化模型可能是一个很好的替代方案。本研究的目的是设计并开发一种具有逼真CT衰减的患者特异性三维颅骨和脑模型，适用于传统和增强现实（AR）导航的神经外科模拟。
使用锥形束CT（CBCT）研究用于颅骨和脑模型的材料的放射密度，并与人类颅骨和脑的放射密度进行比较。在实验室中测试所考虑材料的力学性能，随后由临床经验丰富的神经外科医生进行评估。通过测试和改进的反馈循环对模型进行优化以达到预期目的。
使用聚乳酸和碳酸钙通过3D打印制作出包括鼻腔和颅底完整呈现的颅骨。在从尸体的CBCT和T1加权磁共振图像分割得到的模具中，使用水和冷却剂的混合物，加入4 wt%的聚乙烯醇和0.1 wt%的硫酸钡浇铸出脑模型。实验显示，颅骨和脑模型的放射密度分别为547和38亨氏单位（HU），而真实颅骨和脑组织的放射密度值分别约为1300和30 HU。至于力学性能测试，脑模型表现出与真实脑组织相似的弹性。随后神经外科医生在鼻内颅底手术、脑活检和外置脑室引流（EVD）放置的模拟中对该模型进行了评估，发现其满足手术模型的要求。
设计出一种逼真且与CT兼容的拟人化头部模型，并成功用于模拟增强现实引导的神经外科手术。颅底和脑的解剖细节得到了逼真再现。该模型易于制造，可低成本用于手术培训。
