van Doormaal Jesse A M, Fick Tim, Boskovic Ernest, Hoving Eelco W, Robe Pierre A J T, van Doormaal Tristan P C
Department of Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Medical Technology and Clinical Physics, University Medical Centre Utrecht, Utrecht, The Netherlands.
J Med Syst. 2025 Jan 3;49(1):1. doi: 10.1007/s10916-024-02133-4.
This study aimed to develop and validate a cost-effective, customizable patient-specific phantom for simulating external ventricular drain placement, combining image segmentation, 3-D printing and molding techniques. Two variations of the phantom were created based on patient MRI data, integrating a realistic skin layer with anatomical landmarks, a 3-D printed skull, an agarose polysaccharide gel brain, and a ventricular cavity. To validate the phantom, 15 neurosurgeons, residents, and physician assistants performed 30 EVD placements. The effectiveness of the phantom as a training tool was assessed through a standardized user experience questionnaire, which evaluated the physical attributes, realism, and overall satisfaction. The mechanical properties of the phantom brain were quantified by measuring catheter insertion forces using a linear force tester to compare them to those experienced in real brain tissue. The study participants successfully completed EVD placements with a 76.7% optimal placement rate, which aligns with rates observed in clinical practice. Feedback highlighted the anatomical accuracy of the phantom and its value in enhancing surgical skills, though it also identified areas for improvement, particularly in the realism of the skin layer. Mechanical testing demonstrated that the insertion forces required were comparable to those encountered in actual brain tissue. The developed phantom offers a realistic, low-cost, and adaptable model for EVD simulation. This tool is particularly beneficial for both training and research, with future enhancements planned to improve the realism of the skin and incorporate more anatomical features to increase the fidelity of the simulation.
本研究旨在开发并验证一种经济高效、可定制的患者特异性模型，用于模拟体外脑室引流管置入，结合图像分割、3D打印和成型技术。基于患者的MRI数据创建了两种模型变体，将逼真的皮肤层与解剖标志、3D打印的颅骨、琼脂糖凝胶脑和脑室腔整合在一起。为了验证该模型，15名神经外科医生、住院医师和医师助理进行了30次体外脑室引流管置入操作。通过标准化的用户体验问卷评估该模型作为培训工具的有效性，该问卷评估了物理属性、逼真度和总体满意度。使用线性力测试仪测量导管插入力来量化模型脑的力学性能，以便与在真实脑组织中所经历的力进行比较。研究参与者成功完成了体外脑室引流管置入操作，最佳置入率为76.7%，这与临床实践中观察到的比率一致。反馈突出了该模型的解剖准确性及其在提高手术技能方面的价值，不过也指出了需要改进的方面，特别是皮肤层的逼真度。力学测试表明，所需的插入力与在实际脑组织中遇到的力相当。所开发的模型为体外脑室引流管模拟提供了一个逼真、低成本且适应性强的模型。该工具对培训和研究都特别有益，计划在未来进行改进，以提高皮肤的逼真度并纳入更多解剖特征，从而提高模拟的逼真度。
