Department of Information Engineering, University of Brescia, Brescia, Italy.
Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
Neurosurg Rev. 2023 Sep 19;46(1):248. doi: 10.1007/s10143-023-02149-3.
Endoscopic transsphenoidal surgery is a novel surgical technique requiring specific training. Different models and simulators have been recently suggested for it, but no systematic review is available. To provide a systematic and critical literature review and up-to-date description of the training models or simulators dedicated to endoscopic transsphenoidal surgery. A search was performed on PubMed and Scopus databases for articles published until February 2023; Google was also searched to document commercially available. For each model, the following features were recorded: training performed, tumor/arachnoid reproduction, assessment and validation, and cost. Of the 1199 retrieved articles, 101 were included in the final analysis. The described models can be subdivided into 5 major categories: (1) enhanced cadaveric heads; (2) animal models; (3) training artificial solutions, with increasing complexity (from "box-trainers" to multi-material, ct-based models); (4) training simulators, based on virtual or augmented reality; (5) Pre-operative planning models and simulators. Each available training model has specific advantages and limitations. Costs are high for cadaver-based solutions and vary significantly for the other solutions. Cheaper solutions seem useful only for the first stages of training. Most models do not provide a simulation of the sellar tumor, and a realistic simulation of the suprasellar arachnoid. Most artificial models do not provide a realistic and cost-efficient simulation of the most delicate and relatively common phase of surgery, i.e., tumor removal with arachnoid preservation; current research should optimize this to train future neurosurgical generations efficiently and safely.
经蝶窦内镜手术是一种需要特定培训的新型手术技术。最近已经提出了不同的模型和模拟器,但没有系统的综述。本文旨在提供一个系统的和批判性的文献综述,并对专门用于经蝶窦内镜手术的培训模型或模拟器进行最新描述。在 PubMed 和 Scopus 数据库中搜索截至 2023 年 2 月发表的文章,并在 Google 上搜索记录商业上可用的模型。对于每个模型,记录了以下特征:培训内容、肿瘤/蛛网膜再现、评估和验证以及成本。在检索到的 1199 篇文章中,有 101 篇被纳入最终分析。描述的模型可以分为 5 大类:(1)增强的尸体头颅;(2)动物模型;(3)培训人工解决方案,复杂性逐渐增加(从“箱式训练器”到多材料、基于 CT 的模型);(4)基于虚拟现实或增强现实的培训模拟器;(5)术前规划模型和模拟器。每个可用的培训模型都有其特定的优点和局限性。基于尸体的解决方案成本较高,而其他解决方案的成本差异很大。更便宜的解决方案似乎仅适用于培训的最初阶段。大多数模型不能模拟鞍内肿瘤,也不能真实模拟鞍上蛛网膜。大多数人工模型不能真实和经济有效地模拟手术中最精细和相对常见的阶段,即蛛网膜保留下的肿瘤切除;目前的研究应优化这一点,以便有效地和安全地培训未来的神经外科医生。
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