Simulation has become an important tool in neurosurgical education as part of the complex process of improving residents' technical expertise while preserving patient safety. Although different simulators have already been designed for a variety of neurosurgical procedures, spine simulators are still in their infancy and, at present, there is no available simulator for lumbar spine pathologies in pediatric neurosurgery. In this paper the authors describe the peculiarities and challenges involved in developing a synthetic simulator for pediatric lumbar spine pathologies, including tethered spinal cord syndrome and open neural tube defects.
The Department of Neurosurgery of the University of Illinois at Peoria, in a joint program with the Mechanical Engineering Department of Bradley University, designed and developed a general synthetic model for simulating pediatric neurosurgical interventions on the lumbar spine. The model was designed to be composed of several sequential layers, so that each layer might closely mimic the tensile properties of the natural tissues under simulation. Additionally, a system for pressure monitoring was developed to enable precise measurements of the degree of manipulation of the spinal cord.
The designed prototype successfully simulated several scenarios commonly found in pediatric neurosurgery, such as tethered spinal cord, retethered spinal cord, and fatty terminal filum, as well as meningocele, myelomeningocele, and lipomyelomeningocele. Additionally, the formulated grading system was able to account for several variables involved in the qualitative evaluation of the technical performance during the training sessions and, in association with an expert qualitative analysis of the recorded sessions, proved to be a useful feedback tool for the trainees.
Designing and building a synthetic simulator for pediatric lumbar spine pathologies poses a wide variety of unique challenges. According to the authors' experience, a modular system composed of separable layers that can be independently replaced significantly enhances the applicability of such a model, enabling its individualization to distinctive but interrelated pathologies. Moreover, the design of a system for pressure monitoring (as well as a general score that may be able to account for the overall technical quality of the trainee's performance) may further enhance the educational applications of a simulator of this kind so that it can be further incorporated into the neurosurgical residency curriculum for training and evaluation purposes.
Abbreviation used in this paper:PGY = Postgraduate Year.
Address correspondence to: Tobias A. Mattei, M.D., Department of Neurosurgery, University of Illinois at Peoria, 530 NE Glen Oak, #7430, Peoria, Illinois 61637. email: email@example.com.
Please include this information when citing this paper: published online May 24, 2013; DOI: 10.3171/2013.4.PEDS12540.
BanerjeePPLucianoCJLemoleGMJrCharbelFTOhMY: Accuracy of ventriculostomy catheter placement using a head- and hand-tracked high-resolution virtual reality simulator with haptic feedback. J Neurosurg107:515–5212007
BotdenSMBuzinkSNSchijvenMPJakimowiczJJ: Augmented versus virtual reality laparoscopic simulation: what is the difference? A comparison of the ProMIS augmented reality laparoscopic simulator versus LapSim virtual reality laparoscopic simulator. World J Surg31:764–7722007
ClarkJSodergrenMNoonanDDarziAYangGZ: The natural orifice simulated surgical environment (NOSsE): exploring the challenges of NOTES without the animal model. J Laparoendosc Adv Surg Tech A19:211–2142009
CondinoSCarboneMFerrariVFaggioniLPeriAFerrariM: How to build patient-specific synthetic abdominal anatomies. An innovative approach from physical toward hybrid surgical simulators. Int J Med Robot7:202–2132011
FerroliPTrignaliGAcerbiFAquinoDFranziniABroggiG: Brain surgery in a stereoscopic virtual reality environment: a single institution's experience with 100 cases. Neurosurgery67:3 Suppl Operativeons79–ons842010
LehmannKSRitzJPMaassHCakmakHKKuehnapfelUGGermerCT: A prospective randomized study to test the transfer of basic psychomotor skills from virtual reality to physical reality in a comparable training setting. Ann Surg241:442–4492005
LucianoCJBanerjeePPBellotteBOhGMLemoleMJrCharbelFT: Learning retention of thoracic pedicle screw placement using a high-resolution augmented reality simulator with haptic feedback. Neurosurgery69:1 Suppl Operativeons14–ons192011
PriceJNaikVBoodhwaniMBrandysTHendryPLamBK: A randomized evaluation of simulation training on performance of vascular anastomosis on a high-fidelity in vivo model: the role of deliberate practice. J Thorac Cardiovasc Surg142:496–5032011
SeldenNROrigitanoTCBurchielKJGetchCCAndersonVCMcCartneyS: A national fundamentals curriculum for neurosurgery PGY1 residents: the 2010 Society of Neurological Surgeons boot camp courses. Neurosurgery70:971–9812012
Shamim KhanMAhmedKGavazziAGohilRThomasLPoulsenJ: Development and implementation of centralized simulation training: evaluation of feasibility, acceptability and construct validity. BJU Int111:518–5232012
Van SickleKRRitterEMMcCluskyDAIIILedermanABaghaiMGallagherAG: Attempted establishment of proficiency levels for laparoscopic performance on a national scale using simulation: the results from the 2004 SAGES Minimally Invasive Surgical Trainer-Virtual Reality (MISTVR) learning center study. Surg Endosc21:5–102007
WebsterRHarrisMShenkRBlumenstockJGerberJBillmanC: Using an approximation to the euclidean skeleton for efficient collision detection and tissue deformations in surgical simulators. Stud Health Technol Inform111:596–5982005