Civilla Lorenzo, Dodier Philippe, Palumbo Maria Chiara, Redaelli Alberto C L, Koenigshofer Markus, Unger Ewald, Meling Torstein R, Velinov Nikolay, Rössler Karl, Moscato Francesco
Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.
3D Print Med. 2024 Sep 18;10(1):30. doi: 10.1186/s41205-024-00235-w.
Microsurgical clipping is a delicate neurosurgical procedure used to treat complex Unruptured Intracranial Aneurysms (UIAs) whose outcome is dependent on surgeon's experience. Simulations are emerging as excellent complements to standard training, but their adoption is limited by the realism they provide. The aim of this study was to develop and validate a microsurgical clipping simulator platform.
Physical and holographic simulators of UIA clipping have been developed. The physical phantom consisted of a 3D printed hard skull and five (n = 5) rapidly interchangeable, perfused and fluorescence compatible 3D printed aneurysm silicone phantoms. The holographic clipping simulation included a real-time finite-element-model of the aneurysm sac, allowing interaction with a virtual clip and its occlusion. Validity, usability, usefulness and applications of the simulators have been assessed through clinical scores for aneurysm occlusion and a questionnaire study involving 14 neurosurgical residents (R) and specialists (S) for both the physical () and holographic () simulators by scores going from 1 (very poor) to 5 (excellent).
The physical simulator allowed to replicate successfully and accurately the patient-specific anatomy. UIA phantoms were manufactured with an average dimensional deviation from design of 0.096 mm and a dome thickness of 0.41 ± 0.11 mm. The holographic simulation executed at 25-50 fps allowing to gain unique insights on the anatomy and testing of the application of several clips without manufacturing costs. Aneurysm closure in the physical model evaluated by fluorescence simulation and post-operative CT revealed Raymond 1 (full) occlusion respectively in 68.89% and 73.33% of the cases. For both the simulators content validity, construct validity, usability and usefulness have been observed, with the highest scores observed in clip selection usefulness R=4.78, S=5.00 and R=4.00, S=5.00 for the printed and holographic simulators.
Both the physical and the holographic simulators were validated and resulted usable and useful in selecting valid clips and discarding unsuitable ones. Thus, they represent ideal platforms for realistic patient-specific simulation-based training of neurosurgical residents and hold the potential for further applications in preoperative planning.
显微手术夹闭是一种精细的神经外科手术，用于治疗复杂的未破裂颅内动脉瘤（UIA），其手术结果取决于外科医生的经验。模拟正成为标准培训的优秀补充，但它们的采用受到其提供的真实感的限制。本研究的目的是开发并验证一个显微手术夹闭模拟器平台。
已开发出UIA夹闭的物理模拟器和全息模拟器。物理模型由一个3D打印的硬颅骨和五个（n = 5）可快速互换、灌注且兼容荧光的3D打印动脉瘤硅胶模型组成。全息夹闭模拟包括动脉瘤囊的实时有限元模型，允许与虚拟夹子及其闭塞情况进行交互。通过动脉瘤闭塞的临床评分以及一项涉及14名神经外科住院医师（R）和专家（S）的问卷调查研究，对物理模拟器（ ）和全息模拟器（ ）的有效性、可用性、实用性和应用进行了评估，评分从1（非常差）到5（优秀）。
物理模拟器能够成功且准确地复制患者特定的解剖结构。UIA模型制造时的尺寸平均偏差与设计值为0.096毫米，穹顶厚度为0.41±0.11毫米。全息模拟以25 - 50帧/秒的速度执行，能够在不产生制造成本的情况下，对解剖结构以及多种夹子应用的测试获得独特见解。通过荧光模拟和术后CT评估，物理模型中的动脉瘤闭塞情况显示，分别有68.89%和73.33%的病例达到雷蒙德1级（完全）闭塞。对于这两种模拟器，均观察到内容效度、结构效度、可用性和实用性，在夹子选择实用性方面得分最高，物理模拟器中住院医师得分为4.78、专家得分为5.00，全息模拟器中住院医师得分为4.00、专家得分为5.00。
物理模拟器和全息模拟器均经过验证，在选择有效夹子和摒弃不合适夹子方面具有可用性和实用性。因此，它们是神经外科住院医师基于患者特定模拟的逼真培训的理想平台，并在术前规划中具有进一步应用的潜力。
