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Nícollas Nunes Rabelo, Bruno Braga Sisnando da Costa, Manoel Jacobsen Teixeira and Eberval Gadelha Figueiredo

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Giselle Coelho, Eberval Gadelha Figueiredo, Nícollas Nunes Rabelo, Manoel Jacobsen Teixeira and Nelci Zanon

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.

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Nícollas Nunes Rabelo, Manoel Jacobsen Teixeira, Robert F. Spetzler and Eberval Gadelha Figueiredo

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Nícollas Nunes Rabelo, Renan Salomão Rodrigues, Arthur Araújo Massoud Salame, Paulo Henrique Braz-Silva, Manoel Jacobsen Teixeira and Eberval Gadelha Figueiredo

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Nícollas Nunes Rabelo, Manoel Jacobsen Teixeira and Eberval Gadelha Figueiredo

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Nícollas Nunes Rabelo, Bruno Braga Sisnando da Costa, Gabriel Reis Sakaya, Manoel Jacobsen Teixeira and Eberval Gadelha Figueiredo

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Giselle Coelho, Nicollas Nunes Rabelo, Eduardo Vieira, Kid Mendes, Gustavo Zagatto, Ricardo Santos de Oliveira, Cassio Eduardo Raposo-Amaral, Maurício Yoshida, Matheus Rodrigues de Souza, Caroline Ferreira Fagundes, Manoel Jacobsen Teixeira and Eberval Gadelha Figueiredo

OBJECTIVE

The main objective of neurosurgery is to establish safe and reliable surgical techniques. Medical technology has advanced during the 21st century, enabling the development of increasingly sophisticated tools for preoperative study that can be used by surgeons before performing surgery on an actual patient. Laser-printed models are a robust tool for improving surgical performance, planning an operative approach, and developing the skills and strategy to deal with uncommon and high-risk intraoperative difficulties. Practice with these models enhances the surgeon’s understanding of 3D anatomy but has some limitations with regard to tactile perception. In this study, the authors aimed to develop a preoperative planning method that combines a hybrid model with augmented reality (AR) to enhance preparation for and planning of a specific surgical procedure, correction of metopic craniosynostosis, also known as trigonocephaly.

METHODS

With the use of imaging data of an actual case patient who underwent surgical correction of metopic craniosynostosis, a physical hybrid model (for hands-on applications) and an AR app for a mobile device were created. The hybrid customized model was developed by using analysis of diagnostic CT imaging of a case patient with metopic craniosynostosis. Created from many different types of silicone, the physical model simulates anatomical conditions, allowing a multidisciplinary team to deal with different situations and to precisely determine the appropriate surgical approach. A real-time AR interface with the physical model was developed by using an AR app that enhances the anatomic aspects of the patient’s skull. This method was used by 38 experienced surgeons (craniofacial plastic surgeons and neurosurgeons), who then responded to a questionnaire that evaluated the realism and utility of the hybrid AR simulation used in this method as a beneficial educational tool for teaching and preoperative planning in performing surgical metopic craniosynostosis correction.

RESULTS

The authors developed a practice model for planning the surgical cranial remodeling used in the correction of metopic craniosynostosis. In the hybrid AR model, all aspects of the surgical procedure previously performed on the case patient were simulated: subcutaneous and subperiosteal dissection, skin incision, and skull remodeling with absorbable miniplates. The pre- and postoperative procedures were also carried out, which emphasizes the role of the AR app in the hybrid model. On the basis of the questionnaire, the hybrid AR tool was approved by the senior surgery team and considered adequate for educational purposes. Statistical analysis of the questionnaire responses also highlighted the potential for the use of the hybrid model in future applications.

CONCLUSIONS

This new preoperative platform that combines physical and virtual models may represent an important method to improve multidisciplinary discussion in addition to being a powerful teaching tool. The hybrid model associated with the AR app provided an effective training environment, and it enhanced the teaching of surgical anatomy and operative strategies in a challenging neurosurgical procedure.