A microcontroller-based simulation of dural venous sinus injury for neurosurgical training

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OBJECTIVE

Surgical simulation has the potential to supplement and enhance traditional resident training. However, the high cost of equipment and limited number of available scenarios have inhibited wider integration of simulation in neurosurgical education. In this study the authors provide initial validation of a novel, low-cost simulation platform that recreates the stress of surgery using a combination of hands-on, model-based, and computer elements. Trainee skill was quantified using multiple time and performance measures. The simulation was initially validated using trainees at the start of their intern year.

METHODS

The simulation recreates intraoperative superior sagittal sinus injury complicated by air embolism. The simulator model consists of 2 components: a reusable base and a disposable craniotomy pack. The simulator software is flexible and modular to allow adjustments in difficulty or the creation of entirely new clinical scenarios. The reusable simulator base incorporates a powerful microcomputer and multiple sensors and actuators to provide continuous feedback to the software controller, which in turn adjusts both the screen output and physical elements of the model. The disposable craniotomy pack incorporates 3D-printed sections of model skull and brain, as well as artificial dura that incorporates a model sagittal sinus.

RESULTS

Twelve participants at the 2015 Western Region Society of Neurological Surgeons postgraduate year 1 resident course (“boot camp”) provided informed consent and enrolled in a study testing the prototype device. Each trainee was required to successfully create a bilateral parasagittal craniotomy, repair a dural sinus tear, and recognize and correct an air embolus. Participant stress was measured using a heart rate wrist monitor. After participation, each resident completed a 13-question categorical survey.

CONCLUSIONS

All trainee participants experienced tachycardia during the simulation, although the point in the simulation at which they experienced tachycardia varied. Survey results indicated that participants agreed the simulation was realistic, created stress, and was a useful tool in training neurosurgical residents. This simulator represents a novel, low-cost approach for hands-on training that effectively teaches and tests residents without risk of patient injury.

ABBREVIATIONS bpm = beats per minute; HR = heart rate; OHSU = Oregon Health & Science University; PGY1 = postgraduate year 1; SNS = Society of Neurological Surgeons.

Article Information

Correspondence Nathan R. Selden, Department of Neurological Surgery, Oregon Health & Science University, Mail code: CH8N, 3303 SW Bond Ave., Portland, OR 97239. email: seldenn@ohsu.edu.

INCLUDE WHEN CITING Published online June 2, 2017; DOI: 10.3171/2016.12.JNS162165.

Drs. Cleary and Siler contributed equally to this work.

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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    Design flowchart of the simulation course (see Methods).

  • View in gallery

    Photographs of simulation materials. A: Completed device prototype, with all components mounted inside the base head model, showing the flow controller, flowmeter, and associated tubing. B: Simulation equipment setup. Additional equipment included operating drapes, towels, a craniotomy drill, standard surgical tools, and suture material. C: A trainee undertaking dural venous sinus repair during the simulation. D: Changes in vital signs with development of a venous air embolus, including tachycardia, hypotension, and oxygen desaturation, are displayed on a clinical monitor during the simulation. Figure is available in color online only.

  • View in gallery

    A: A neurosurgical trainee (Trainee HR) demonstrates periodic tachycardia in association with the events of the simulation. B: An attending physician (Faculty HR) does not demonstrate tachycardia during the simulation, although there are small variations of HR during simulation events. C: Mean HR of both trainee and faculty study participants. D: Peak HR compared with mean HR for trainee and faculty study participants (n = 12). *p < 0.05.

  • View in gallery

    Portion of categorical responses to survey questions regarding experience on the simulation. Responses are organized by question. OR = operating room.

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