Development and evaluation of a new pediatric mixed-reality model for neurosurgical training

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OBJECTIVE

Craniosynostosis is a premature cranial suture junction and requires a craniectomy to decrease cranial compression and remodel the affected areas of the skull. However, mastering these neurosurgical procedures requires many years of supervised training. The use of surgical simulation can reduce the risk of intraoperative error. The authors propose a new instrument for neurosurgical education, which mixes reality with virtual and realistic simulation for repair of craniosynostosis (scaphocephaly type).

METHODS

This study tested reality simulators with a synthetic thermo-retractile/thermosensitive rubber joined with different polymers. To validate the model, 18 experienced surgeons participated in this study using 3D videos developed using 3DS Max software. Renier’s “H” technique for craniosynostosis correction was applied during the simulation. All participants completed questionnaires to evaluate the simulator.

RESULTS

An expert surgical team approved the craniosynostosis reality and virtual simulators. More than 94% of participants found the simulator relevant, considering aspects such as weight, surgical positioning, dissection by planes, and cranial reconstruction. The consistency and material resistance were also approved on average by more than 60% of the surgeons.

CONCLUSIONS

The virtual simulator demands a high degree of effectiveness with 3D perception in anatomy and operative strategies in neurosurgical training. Physical and virtual simulation with mixed reality required psychomotor and cognitive abilities otherwise acquired only during practical surgical training with supervision.

Article Information

Correspondence Eberval Gadelha Figueiredo: University of São Paulo, Brazil. ebgadelha@yahoo.com.

INCLUDE WHEN CITING Published online August 2, 2019; DOI: 10.3171/2019.2.PEDS18597.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Images from the craniosynostosis virtual simulator. A–C: Patient positioning, skin incision, and dissection by planes. D–I: Defining the area for craniotomy using Renier’s “H” technique. J: Green-stick fracture. K and L: Sagittal strip removal. M and N: Use of absorbable plates. Values given in panels D, E, F, and H are in centimeters. Figure is available in color online only.

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    Images of the realistic craniosynostosis simulator. A and B: Craniosynostosis surgical unit. C: Connection point between the surgical unit (head) and the base of the simulator. D: Anatomical model ready to use. Reprinted by permission from Springer Nature, Childs Nerv Syst. Anatomical pediatric model for craniosynostosis surgical training. Coelho G, Warf B, Lyra M, Zanon N. Copyright 2014. Figure is available in color online only.

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    CT scans of the physical simulator. Panels B and C are 3D reconstructions. Reprinted by permission from Springer Nature, Childs Nerv Syst. Anatomical pediatric model for craniosynostosis surgical training. Coelho G, Warf B, Lyra M, Zanon N. Copyright 2014. Figure is available in color online only.

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    Patient positioning, the first step of the surgical simulation. Reprinted by permission from Springer Nature, Childs Nerv Syst. Anatomical pediatric model for craniosynostosis surgical training. Coelho G, Warf B, Lyra M, Zanon N. Copyright 2014. Figure is available in color online only.

  • View in gallery

    A and B: Real simulator in the operating room and delimiting the skin incision. C and D: Subcutaneous dissection. E and F: Subperiosteal dissection. G and H: Delimiting the osteotomy. I and J: Green-stick fracture (Renier’s “H” technique). K and L: Cranial reconstruction (using absorbable plates). M and N: Skin closure. Reprinted by permission from Springer Nature, Childs Nerv Syst. Anatomical pediatric model for craniosynostosis surgical training. Coelho G, Warf B, Lyra M, Zanon N. Copyright 2014. Figure is available in color online only.

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