Tag: simulation

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Training on a 3D-Printed Simulation Model Improves Accuracy in External Ventricular Drain Placement

Operative Neurosurgery 29:418–427, 2025

Training neurosurgeons on a 3D-printed simulation model with a standardized protocol significantly improved external ventricular drain (EVD) placement accuracy, reduced variability, and increased confidence, benefitting both junior and experienced practitioners. Regular simulation-based training is recommended to maintain high clinical performance and standardize EVD procedures.

• 3D-printed head models were developed for training neurosurgical residents in external ventricular drain (EVD) placement.

• Training included pre-training, standardized protocol with neuronavigation, and post-training rounds.

• EVD placement accuracy improved significantly after training, with optimal placement rates rising from 55% to 84%.

• Distances to ideal entry and target points, as well as procedure times, were significantly reduced post-training.

• Experience alone did not predict accuracy; even senior neurosurgeons improved, and post-training results were similar across experience levels.

• Right-handed participants achieved better outcomes using their right hand for both sides; left-sided EVDs were more often misplaced.

• Participants’ confidence in EVD placement and direction increased after training.

• Regular, standardized simulation training is recommended for all neurosurgeons, regardless of experience, to maintain high clinical performance.

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Seven bypasses simulation set: description and validity assessment of novel models for microneurosurgical training

J Neurosurg 138:732–739, 2023

Microsurgical training remains indispensable to master cerebrovascular bypass procedures, but simulation models for training that accurately replicate microanastomosis in narrow, deep-operating corridors are lacking. Seven simulation bypass scenarios were developed that included head models in various surgical positions with premade approaches, simulating the restrictions of the surgical corridors and hand positions for microvascular bypass training. This study describes these models and assesses their validity.

METHODS Simulation models were created using 3D printing of the skull with a designed craniotomy. Brain and external soft tissues were cast using a silicone molding technique from the clay-sculptured prototypes. The 7 simulation scenarios included: 1) temporal craniotomy for a superficial temporal artery (STA)–middle cerebral artery (MCA) bypass using the M4 branch of the MCA; 2) pterional craniotomy and transsylvian approach for STA-M2 bypass; 3) bifrontal craniotomy and interhemispheric approach for side-to-side bypass using the A3 branches of the anterior cerebral artery; 4) far lateral craniotomy and transcerebellomedullary approach for a posterior inferior cerebellar artery (PICA)–PICA bypass or 5) PICA reanastomosis; 6) orbitozygomatic craniotomy and transsylvian-subtemporal approach for a posterior cerebral artery bypass; and 7) extended retrosigmoid craniotomy and transcerebellopontine approach for an occipital artery–anterior inferior cerebellar artery bypass. Experienced neurosurgeons evaluated each model by practicing the aforementioned bypasses on the models. Face and content validities were assessed using the bypass participant survey.

RESULTS A workflow for model production was developed, and these models were used during microsurgical courses at 2 neurosurgical institutions. Each model is accompanied by a corresponding prototypical case and surgical video, creating a simulation scenario. Seven experienced cerebrovascular neurosurgeons practiced microvascular anastomoses on each of the models and completed surveys. They reported that actual anastomosis within a specific approach was well replicated by the models, and difficulty was comparable to that for real surgery, which confirms the face validity of the models. All experts stated that practice using these models may improve bypass technique, instrument handling, and surgical technique when applied to patients, confirming the content validity of the models.

CONCLUSIONS The 7 bypasses simulation set includes novel models that effectively simulate surgical scenarios of a bypass within distinct deep anatomical corridors, as well as hand and operator positions. These models use artificial materials, are reusable, and can be implemented for personal training and during microsurgical courses.

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USim: A New Device and App for Case-Specific, Intraoperative Ultrasound Simulation and Rehearsal in Neurosurgery

Operative Neurosurgery 14:572–578, 2018

Intraoperative ultrasound (iUS) is an excellent aid for neurosurgeons to perform better and safer operations thanks to real time, continuous, and high-quality intraoperative visualization. OBJECTIVE: To develop an innovative training method to teach how to perform iUS in neurosurgery.

METHODS: Patients undergoing surgery for different brain or spine lesions were iUS scanned (before opening the dura) in order to arrange a collection of 3-dimensional, US images; this set of data was matched and paired to preoperatively acquired magnetic resonance images in order to create a library of neurosurgical cases to be studied offline for training and rehearsal purposes. This new iUS training approach was preliminarily tested on 14 European neurosurgery residents, who participated at the 2016 European Association of Neurosurgical Societies Training Course (Sofia, Bulgaria).

RESULTS: USim was developed by Camelot and the Besta NeuroSim Center as a dedicated app that transforms any smartphone into a “virtual US probe,” in order to simulate iUS applied to neurosurgery on a series of anonymized, patient-specific cases of different central nervous system tumors (eg, gliomas, metastases, meningiomas) for education, simulation, and rehearsal purposes. USim proved to be easy to use and allowed residents to quickly learn to handle a US probe and interpret iUS semiotics.

CONCLUSION: USim could help neurosurgeons learn neurosurgical iUS safely. Furthermore, neurosurgeons could simulate many cases, of different brain/spinal cord tumors, that resemble the specific cases they have to operate on. Finally, the library of caseswould be continuously updated, upgraded, and made available to neurosurgeons.

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The use of simulation in neurosurgical education and training

Simulation in neurosurgical training

J Neurosurg 121:228–246, 2014

There is increasing evidence that simulation provides high-quality, time-effective training in an era of resident duty-hour restrictions. Simulation may also permit trainees to acquire key skills in a safe environment, important in a specialty such as neurosurgery, where technical error can result in devastating consequences. The authors systematically reviewed the application of simulation within neurosurgical training and explored the state of the art in simulation within this specialty. To their knowledge this is the first systematic review published on this topic to date.

Methods. The authors searched the Ovid MEDLINE, Embase, and PsycINFO databases and identified 4101 articles; 195 abstracts were screened by 2 authors for inclusion. The authors reviewed data on study population, study design and setting, outcome measures, key findings, and limitations.

Results. Twenty-eight articles formed the basis of this systematic review. Several different simulators are at the neurosurgeon’s disposal, including those for ventriculostomy, neuroendoscopic procedures, and spinal surgery, with evidence for improved performance in a range of procedures. Feedback from participants has generally been favorable. However, study quality was found to be poor overall, with many studies hampered by nonrandomized design, presenting normal rather than abnormal anatomy, lack of control groups and long-term follow-up, poor study reporting, lack of evidence of improved simulator performance translating into clinical benefit, and poor reliability and validity evidence. The mean Medical Education Research Study Quality Instrument score of included studies was 9.21 ± 1.95 (± SD) out of a possible score of 18.

Conclusions. The authors demonstrate qualitative and quantitative benefits of a range of neurosurgical simulators but find significant shortfalls in methodology and design. Future studies should seek to improve study design and reporting, and provide long-term follow-up data on simulated and ideally patient outcomes.

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Novel embalming solution for neurosurgical simulation in cadavers

Novel embalming solution for surgical simulation

J Neurosurg 120:1229–1237, 2014

Surgical simulation using postmortem human heads is one of the most valid strategies for neurosurgical research and training. The authors customized an embalming formula that provides an optimal retraction profile and lifelike physical properties while preventing microorganism growth and brain decay for neurosurgical simulations in cadavers. They studied the properties of the customized formula and compared its use with the standard postmortem processing techniques: cryopreservation and formaldehyde-based embalming.

Methods. Eighteen specimens were prepared for neurosurgical simulation: 6 formaldehyde embalmed, 6 cryopreserved, and 6 custom embalmed. The customized formula is a mixture of ethanol 62.4%, glycerol 17%, phenol 10.2%, formaldehyde 2.3%, and water 8.1%. After a standard pterional craniotomy, retraction profiles and brain stiffness were studied using an intracranial pressure transducer and monitor. Preservation time—that is, time that tissue remained in optimal condition—between specimen groups was also compared through periodical reports during a 48-hour simulation.

Results. The mean (± standard deviation) retraction pressures were highest in the formaldehyde group and lowest in the cryopreserved group. The customized formula provided a mean retraction pressure almost 3 times lower than formaldehyde (36 ± 3 vs 103 ± 14 mm Hg, p < 0.01) and very similar to cryopreservation (24 ± 6 mm Hg, p < 0.01). For research purposes, preservation time in the cryopreserved group was limited to 4 hours and was unlimited for the customized and formaldehyde groups for the duration of the experiment.

Conclusions. The customized embalming solution described herein is optimal for allowing retraction and surgical maneuverability while preventing decay. The authors were able to significantly lower the formaldehyde content as compared with that in standard formulas. The custom embalming solution has the benefits from both cryopreservation (for example, biological brain tissue properties) and formaldehyde embalming (for example, preservation time and microorganism growth prevention) and minimizes their drawbacks, that is, rapid decay in the former and stiffness in the latter. The presented embalming formula provides an important advance for neurosurgical simulations in research and teaching.

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Validating the Use of Smartphone-Based Accelerometers for Performance Assessment in a Simulated Neurosurgical Task

Validating the Use of Smartphone-Based Accelerometers for Performance Assessment in a Simulated Neurosurgical Task

Operative Neurosurgery 10:57–65, 2014

Reductions in working hours affect training opportunities for surgeons. Surgical simulation is increasingly proposed to help bridge the resultant training gap. For simulation training to translate effectively into the operating theater, acquisition of technical proficiency must be objectively assessed. Evaluating “economy of movement” is one way to achieve this.

OBJECTIVE: We sought to validate a practical and economical method of assessing economy of movement during a simulated task. We hypothesized that accelerometers, found in smartphones, provide quantitative, objective feedback when attached to a neurosurgeon’s wrists.

METHODS: Subjects (n = 25) included consultants, senior registrars, junior registrars, junior doctors, and medical students. Total resultant acceleration (TRA), average resultant acceleration, and movements with acceleration .0.6g (suprathreshold acceleration events) were recorded while subjects performed a simulated dural closure task.

RESULTS: Students recorded an average TRA 97.0 6 31.2 ms22 higher than senior registrars (P = .03) and 103 6 31.2 ms22 higher than consultants (P = .02). Similarly, junior doctors accrued an average TRA 181 6 31.2 ms22 higher than senior registrars (P , .001) and 187 6 31.2 ms22 higher than consultants (P , .001). Significant correlations were observed between surgical outcome (as measured by quality of dural closure) and both TRA (r = .44, P , .001) and number of suprathreshold acceleration events (r = .33, P, .001). TRA (219 6 66.6 ms22; P = .01) and number of suprathreshold acceleration events (127 6 42.5; P = .02) dropped between the first and fourth trials for junior doctors, suggesting procedural learning. TRA was 45.4 6 17.1 ms22 higher in the dominant hand for students (P = .04) and 57.2 6 17.1 ms22 for junior doctors (P = .005), contrasting with even TRA distribution between hands (acquired ambidexterity) in senior groups.

CONCLUSION: Data from smartphone-based accelerometers show construct validity as an adjunct for assessing technical performance during simulation training.

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Utility of multimaterial 3D printers in creating models with pathological entities to enhance the training experience of neurosurgeons

Utility of multimaterial 3D printers in creating models with pathological entities to enhance the training experience of neurosurgeons

J Neurosurg 120:489–492, 2014

The advent of multimaterial 3D printers allows the creation of neurosurgical models of a more realistic nature, mimicking real tissues.

The authors used the latest generation of 3D printer to create a model, with an inbuilt pathological entity, of varying consistency and density. Using this model the authors were able to take trainees through the basic steps, from navigation and planning of skin flap to performing initial steps in a craniotomy and simple tumor excision.

As the technology advances, models of this nature may be able to supplement the training of neurosurgeons in a simulated operating theater environment, thus improving the training experience

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