Name: simulator training for endovascular neurosurgery
Uploaded: 2020-05-06T12:30:00.000+00:00
Duration: 8 min 8 s
Description: Watch this Scientific Journal Video about Simulator Training for Endovascular Neurosurgery at JoVE.com

作者感谢所有临床团队每天为UCSD神经血管患者的护理做出贡献。

1. 模拟器设置
<ol><li>在所有程序之前，组装图 1中显示的模拟器并打开。有关完成每次模拟所需的模拟器设备的完整列表，请参阅表 1。</li>
	<li>使用附加笔记本电脑上的软件界面（图 1C）选择患者方案。</li>
	<li>从下拉菜单中选择合适的动脉护套或导管。这不需要物理插入作为模拟的一部分，但将作为股骨访问站点，并允许随后进入系统的电线和导管 （图 1D）。下面讨论了每个方案的具体护套/指南大小。</li>
	<li>根据下面讨论的具体方案（图 1D）选择适当的导管、导线线和/或微系统。</li>
	<li>打开软件界面上的 A （PA） 和 B 平面 （横向） 荧光镜检查。用脚踏板激活荧光镜 （图 1H），用操纵杆 （图 1I）调整患者和图像强化器位置，直到获得正确的 PA 和横向视图。</li>
</ol>2. 第一个患者场景:四容器血管造影
注:此场景描绘了一名 52 岁的男性，头部非对比计算断层扫描 （CT） 扫描中偶然发现左胡萝卜素终点动脉瘤。
<ol><li>从下拉菜单中选择 5 法式股骨护套、0.035 导引线和 4 法式诊断导管作为在此模拟中使用的工具。</li>
	<li>将导线插入模拟器机器（图 1D），直到它在模拟屏幕上注册，从而指示已获得访问权限。推进导线，直到它在下降的胸动脉中可视化，并继续进入主动脉拱门。</li>
	<li>当导线安全地位于主动脉拱门中时，将导管保持到位，并通过模拟股骨护套插入导管到主动脉拱门。</li>
	<li>取出导管，利用荧光喷气技术，轻轻按压对比度注射器（图1E），模拟对比注射，并在导管进入所需的动脉时短暂地使血管不透明。</li>
	<li>接下来，创建一个路线图指南注入对比对比注射器 （图 1E），而荧光检查脚踏板是沮丧的 （图1H）.接下来，重新插入导线，有选择地导管所需的容器，推进导管在电线上。拆下电线，进行后续血管造影。左右内、外骨动脉和左右椎动脉均采用此技术导管。</li>
	<li>使用诊断导管和模拟器对比注射器（图1E），通过压低荧光踏板（图1H），同时注射与注射器对比，执行上述每个循环的血管图。如有必要，获取动脉瘤的高放大度视图。在取出导管之前，检查血管图是否足够。</li>
	<li>获取必要的图像后，从模拟护套中取出诊断导管/导线。不执行胎儿动脉切除术部位的模拟关闭。</li>
</ol>3. 第二个患者方案:卡罗蒂德终点动脉瘤盘绕
注:此场景描绘了一名 52 岁的男性，已知左胡萝卜素末期动脉瘤破裂、严重头痛、非焦球检查以及格拉斯哥科马量表分数为 15。
<ol><li>从下拉菜单中选择 6 法制导管、0.035 指南线和 4 法式诊断导管。</li>
	<li>在导管上插入诊断导管到主动脉拱门中，就像步骤 2.2–2.3 一样。</li>
	<li>通过股骨接入部位（图 1D）在诊断导管上插入导管到主动脉拱门。</li>
	<li>取下导线，通过路线图面粉镜脚踏板注射与对比注射器（图1E）形成对比，而荧光镜脚踏板（图1H）则降低，创建左普通胡萝卜动脉的路线图指南。</li>
	<li>重新插入导管，并选择性地导管左普通胡萝卜动脉和内胡萝卜动脉使用荧光镜和路线图覆盖可视化图像投影监视器（图1B），通过领导与导线和推进诊断导管和导管，一旦获得安全访问。</li>
	<li>当导管在内胡萝卜动脉内时，取出诊断导管和导线，通过压低氟镜踏板（图1H）进行左内胡萝卜素脑循环的血管运行，同时注射与注射器对比（图1E）。</li>
	<li>使用软件界面上的计算选项（图 1C）测量动脉瘤。请记住，第一个线圈的线圈直径应比平均动脉瘤直径宽 1 毫米，请选择合适的线圈。</li>
	<li>从下拉菜单中选择微型箱和微线。</li>
	<li>通过股骨接入站点（图 1D）插入微导管和微线，并在步骤 3.6 获得的路线图指导下，有选择地用微系统导管动脉瘤。</li>
	<li>取出微线，通过股骨接入站点插入先前选择的线圈（图1D），然后缓慢地将其推进动脉瘤。</li>
	<li>线圈完全插入后，通过压低氟镜踏板（图1H）进行诊断脑血管造影，同时注射与注射器对比，并评估母动脉和动脉瘤填充物的腹腔。目标是保持母动脉的痉挛，要么完全栓塞动脉瘤，要么提供圆顶的足够覆盖或假定的破裂点，以适当降低破裂风险。</li>
	<li>在软件接口（图1C）上分离线圈，并拆下线圈线。如有必要，重复步骤 3.11 和 3.12 与额外的线圈，直到获得约 30% 动脉瘤闭塞。</li>
	<li>从模拟护套站点（图 1D）中取出微箱并引导导管。不执行胎儿动脉切除术部位的模拟关闭。</li>
</ol>4. 第三个患者方案:左脑动脉血栓切除术
注:此场景描绘了一名 64 岁的女性，其国家卫生研究院中风量表 （NIHSS） 评分为 12，用于失语症和右侧虚弱，她最后已知是正常 4 小时前。头部CT显示一个超凹腹左中脑动脉（MCA）标志和艾伯塔省中风计划早期CT得分（前科）为10，但没有出血。CT血管图显示了左M1段完全遮挡。
<ol><li>从下拉菜单中选择 6 法制导管、0.035 指南线和 4 法式诊断导管。</li>
	<li>将导管插入左内胡萝卜动脉，执行步骤 3.2–3.6 中描述的左内胡萝卜素脑循环的血管运行。</li>
	<li>从下拉菜单中选择微型箱/微线和支架检索器设备。</li>
	<li>将微型导管和微线插入模拟股骨接入部位（图1D）并插入左内胡萝卜动脉。</li>
	<li>在步骤 3.5 获得的路线图指导下，将微线和微箱推进到左 MCA 中，并小心地经过遮挡区域。此操作过程中的潜在并发症包括血管穿孔和/或使下游血块栓塞。</li>
	<li>取出微线，将支架检索器设备插入模拟股骨接入站点（图 1D），并推进到 MCA 分离到闭塞处。然后，取出微箱，将支架检索器留在闭塞水平。</li>
	<li>打开软件界面上的模拟吸气（图1C），通过拉回微线将支架检索器设备缩回导管。</li>
	<li>从模拟股骨访问站点（图 1D）中取出两个支架检索器。</li>
	<li>通过引导导管进行血管造影，压低氟镜踏板（图1H），同时注射与注射器的对比度，以确保消除遮挡。</li>
	<li>从模拟护套站点（图 1D）中取出导管。不执行胎儿动脉切除术部位的模拟关闭。</li>
</ol>

<ol>
	<li>See, K. W., Chui, K. H., Chan, W. H., Wong, K. C., Chan, Y. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evidence+for+Endovascular+Simulation+Training:+A+Systematic+Review.">Evidence for Endovascular Simulation Training: A Systematic Review.</a> European Journal of Vascular and Endovascular Surgery. 51 (3), 441-451 (2016).</li><li>Pannell, J. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulator-Based+Angiography+and+Endovascular+Neurosurgery+Curriculum:+A+Longitudinal+Evaluation+of+Performance+Following+Simulator-Based+Angiography+Training.">Simulator-Based Angiography and Endovascular Neurosurgery Curriculum: A Longitudinal Evaluation of Performance Following Simulator-Based Angiography Training.</a> Cureus. 8 (8), 756 (2016).</li><li>Liebig, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Metric-Based+Virtual+Reality+Simulation:+A+Paradigm+Shift+in+Training+for+Mechanical+Thrombectomy+in+Acute+Stroke.">Metric-Based Virtual Reality Simulation: A Paradigm Shift in Training for Mechanical Thrombectomy in Acute Stroke.</a> Stroke. 49 (7), 239-242 (2018).</li><li>Spiotta, A. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+angiography+skill+acquisition+with+a+secondary+curve+catheter:+phase+2+of+a+curriculum-based+endovascular+simulation+program.">Diagnostic angiography skill acquisition with a secondary curve catheter: phase 2 of a curriculum-based endovascular simulation program.</a> Journal of Neurointerventional Surgery. 7 (10), 777-780 (2015).</li><li>Spiotta, A. M., Rasmussen, P. A., Masaryk, T. J., Benzel, E. C., Schlenk, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulated+diagnostic+cerebral+angiography+in+neurosurgical+training:+a+pilot+program.">Simulated diagnostic cerebral angiography in neurosurgical training: a pilot program.</a> Journal of Neurointerventional Surgery. 5 (4), 376-381 (2013).</li><li>Fargen, K. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experience+with+a+simulator-based+angiography+course+for+neurosurgical+residents:+beyond+a+pilot+program.">Experience with a simulator-based angiography course for neurosurgical residents: beyond a pilot program.</a> Neurosurgery. 73, 46-50 (2013).</li><li>Fargen, K. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulator+based+angiography+education+in+neurosurgery:+results+of+a+pilot+educational+program.">Simulator based angiography education in neurosurgery: results of a pilot educational program.</a> Journal of Neurointerventional Surgery. 4 (6), 438-441 (2012).</li><li>Cates, C., L&#246;nn, L., Gallagher, A. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prospective,+randomised+and+blinded+comparison+of+proficiency-based+progression+full-physics+virtual+reality+simulator+training+versus+invasive+vascular+experience+for+learning+carotid+artery+angiography+by+very+experienced+operators.">Prospective, randomised and blinded comparison of proficiency-based progression full-physics virtual reality simulator training versus invasive vascular experience for learning carotid artery angiography by very experienced operators.</a> BMJ Simulation and Technology Enhanced Learning. 2, 1-5 (2016).</li><li>Guo, J., Jin, X., Guo, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Study+of+the+Operational+Safety+of+a+Vascular+Interventional+Surgical+Robotic+System.">Study of the Operational Safety of a Vascular Interventional Surgical Robotic System.</a> Micromachines. 9 (3), 119 (2018).</li><li>Tedesco, M. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+endovascular+skills+assessment:+the+future+of+credentialing.">Simulation-based endovascular skills assessment: the future of credentialing.</a> Journal of Vascular Surgery. 47 (5), 1008 (2008).</li></ol>

AAK此前曾获得科维迪安公司和佩努姆布拉公司的竞争性资助，并与史崔克神经血管公司、科维迪安公司和佩努姆布拉公司进行医生培训的咨询安排.JSP曾担任斯特里克神经血管和飞镖神经科学有限责任公司的医疗顾问。AAK 和 JSP 与这项工作没有直接的经济利益关系。其余作者没有披露本研究所使用的材料或方法，也未披露本文中指定的发现。

血管内手术是一个扩展的领域，为各种病理提供微创治疗方法。然而，与血管损伤相关的重大风险提供了独特的教育挑战。随着模拟培训的进展，受训人员的教育现在允许在模拟真实案例的无风险环境中进行实践。因此，基于血管内模拟的培训已被证明能够持续改善表现指标，如手术时间、荧光检查时间和对比量，在广泛的参与者（如患者、医科学生、居民和外科医生）1，<...

模拟训练是医学受训人员的既定教育工具，在血管内神经外科等高风险领域尤其有益。存在多个虚拟现实培训设备，利用导管为基础的系统，如ANGIO导师模拟器（Simbionix有限公司，机场城，以色列）和VIST-C和VIST G5模拟器（门蒂斯AB，哥德堡，瑞典），与大量的数据表明程序能力培训的效用1。尽管模拟器很有用，但缺乏用于模拟器的分步程序说明。
呈现的是使用ANGIO导师模拟器的详细协议，该系统支持在常见的血管内神经外科手术的能力改进，包括诊断脑血管造影术，机械血栓切除术，动脉瘤线圈栓塞2。此前的工作表明，各级学员在ANGIO导师模拟器上进行了5次模拟血管造影术、5次输血管切除术和10次动脉瘤线圈栓塞手术后，在程序时间、荧光镜和对比剂量以及不良技术事件2方面都取得了显著改善。
以下分步说明分为案例场景，并可轻松集成到医科学生、居民或研究员2的学术培训课程中。然而，应当指出，需要对脑动脉解剖学、血管造影术、中风和动脉瘤治疗进行基本了解，以优化模拟装置的教育潜力。
以下所有程序（即诊断脑血管造影术、胡萝卜素末期动脉瘤线圈、机械血栓切除术）均可由使用 ANGIO 导师模拟器（Simbionix Ltd.） 的单个操作员执行）（图1） 。这种培训设备允许所有技能级别的神经外科受训人员在产前环境中接触到血管内技术，三个患者场景基于先前公布的模拟器血管学培训2课程。为了重现高保真度血管内技术，模拟器利用通过类似于股动脉护套隔膜的端口引入的实际导管和电线。电线和导管与内部滚筒接合，记录旋转和转换运动，这些运动显示在监视器上。模拟器操作员还可以看到设备选择和患者生命体征。

<table><tbody><tr><td>ANGIO Mentor simulator</td><td>Simbionix Ltd., Airport City, Israel</td><td>N/a</td><td>The setup for the ANGIO Mentor simulator includes the simulator housing as pictured in Figure 1: (A), an external monitor for image projection (x-ray, angiography; B), a laptop for interfacing with the Simbionix Software (C), the simulated femoral artery sheath (with an outer guide-catheter, inner diagnostic microcatheter and guidewire shown; D), a contrast syringe (E), an insufflator for balloon inflation (F), a stent delivery device (G; not used in these patient scenarios), foot pedals for fluoroscopy, roadmap guidance, and angiographic runs (H), and the operator control panel on the simulator housing where the operator is able to control patient and image intensifier positioning (I).</td></tr></tbody></table>

simulator training for endovascular neurosurgery

模拟培训已成为医学专业的常见做法，尤其是学习在高风险环境中执行的复杂技能。在血管内神经外科领域，对无后果和无风险学习环境的需求导致开发对医学受训人员有价值的模拟设备。本协议的目标是为在学术环境中使用血管内神经外科模拟器提供指导性指南。模拟器为受训人员提供了机会，让他们能够收到关于解剖学知识的现实反馈，以及触觉反馈，表明他们在处理基于导管的系统方面取得了成功，而不会产生负面后果。还讨论了这一特定协议与其他神经血管训练模式的效用。

ANGIO 导师模拟器以前被证明在学术环境中执行模拟诊断血管造影、输卵管切除术和动脉瘤线圈破裂栓塞时，能够提高具有不同神经血管体验的外科受训人员的技能。在这项研究中，在30天内，在一名医科学生、一名神经外科住院生、两名诊断神经放射学研究员和一名血管内神经外科研究员中确定了上述程序的性能指标。经过120分钟的教义指导和对每个程序的单次观察，受训者执?...

Watch this Scientific Journal Video about Simulator Training for Endovascular Neurosurgery at JoVE.com

Simulator Training for Endovascular Neurosurgery

模拟复杂、高风险的程序对医学受训人员的教育至关重要。描述了在受控学术环境中进行基于模拟器的血管内神经外科训练的协议。该议定书包括针对不同层次受训人员的分步指南，并讨论了该模式的优势和局限性。

血管内神经外科模拟器培训

Simulation-based training has become common practice across medical specialties, especially for learning complex skills performed in high-risk ...

simulator-training-for-endovascular-neurosurgery

Research

JoVE Journal

Neuroscience

3.5K 次观看.  University of California. 模拟复杂、高风险的程序对医学受训人员的教育至关重要。描述了在受控学术环境中进行基于模拟器的血管内神经外科训练的协议。该议定书包括针对不同层次受训人员的分步指南，并讨论了该模式的优势和局限性。

视频: Simulator Training for Endovascular Neurosurgery

Targeting Neuronal Fiber Tracts for Deep Brain Stimulation Therapy Using Interactive, Patient-Specific Models

Deep brain stimulation (DBS), which involves insertion of an electrode to deliver stimulation to a localized brain region, is an established therapy for movement disorders and is being applied to a growing number of disorders. Computational modeling has been successfully used to predict the clinical effects of DBS; however, there is a need for novel modeling techniques to keep pace with the growing complexity of DBS devices. These models also need to generate predictions quickly and accurately. The goal of this project is to develop an image processing pipeline to incorporate structural magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI) into an interactive, patient specific model to simulate the effects of DBS. A virtual DBS lead can be placed inside of the patient model, along with active contacts and stimulation settings, where changes in lead position or orientation generate a new finite element mesh and solution of the bioelectric field problem in near real-time, a timespan of approximately 10 seconds. This system also enables the simulation of multiple leads in close proximity to allow for current steering by varying anodes and cathodes on different leads. The techniques presented in this paper reduce the burden of generating and using computational models while providing meaningful feedback about the effects of electrode position, electrode design, and stimulation configurations to researchers or clinicians who may not be modeling experts.

The goal of this project is to develop an interactive, patient-specific modeling pipeline to simulate the effects of deep brain stimulation in near real-time and provide meaningful feedback as to how these devices influence neural activity in the brain.

应用交互式、患者特异性模型对神经纤维束进行深部脑刺激治疗的靶向性

Deep brain stimulation (DBS), which involves insertion of an electrode to deliver stimulation to a localized brain region, is an established therapy for ...

科研

生物工程

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can be&#160;achieved by either&#160;thrombolysis with recombinant tissue-plasminogen activator (rt-PA), the standard therapy for stroke patients who present within the first hours of symptom onset without contraindications, or by an endovascular approach, if a proximal brain vessel occlusion is detected. As the efficacy of both therapies declines over time, every minute saved along the way will improve the patient&#39;s outcome.
This critical situation requires thorough work and precise communication with the patient, the family and colleagues from different professions to acquire all relevant information and reach the right decision while carefully monitoring the patient. This is a high fidelity situation. In nonmedical high-fidelity environments such as aviation, Crew Resource Management (CRM) is used to enhance safety and team efficiency.
This guide shows how a Stroke Team algorithm, which is transferable to other hospital settings, was established and how regular simulation-based trainings were performed. It requires determination and endurance to maintain these time-consuming simulation trainings on a regular basis over the course of time. However, the resulting improvement of team spirit and excellent door-to-needle times will benefit both the patients and the work environment in any hospital.
A dedicated Stroke Team of 7 persons who are notified 24/7 by a collective call via speed dial and run a binding algorithm that takes approximately 20 min, was established. To train everybody involved in this algorithm, a simulation-based team training for all new Stroke Team members was conceived and conducted at monthly intervals. This led to a relevant and sustained reduction of the mean door-to-needle time to 25 min, and enhanced the feeling of stroke readiness especially in junior doctors and nurses.

Every min counts in acute stroke care. This guide shows how to establish a Stroke Team algorithm and enhance its performance with regular simulation training. The principles of Crew Resource Management (CRM) facilitate a straight workflow, reduce door-to-needle times and increase staff satisfaction.

建立中风病研究小组算法并进行急诊科基于仿真的培训 - 实用指南

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can ...

医学

Establishing a Multidisciplinary Cavernous Carotid Injury Simulation to Train Neurosurgical, Otolaryngology, and Anesthesia Residents

Carotid artery injuries are serious complications of endoscopic endonasal surgery. As these occur rarely, simulation training offers an avenue for technique and algorithm development in resident learners. This study develops a realistic cadaveric model for the training of crisis resource management in the setting of cavernous carotid artery injury. An expanded endonasal approach and right cavernous carotid injury is performed on a cadaveric head. The cadaver&#39;s right common carotid artery is cannulated and connected to a perfusion pump delivering pressurized simulated blood. A simulation mannequin is incorporated into the model to allow for vital sign feedback. Surgical and anesthesia resident learners are tasked with obtaining vascular control with a muscle patch technique and medical management over the course of 3 clinical scenarios with increasing complexity. Crisis management instructions for an endoscopic endonasal approach to the cavernous carotid artery and blood pressure control were provided to the learners prior to beginning the simulation. An independent reviewer evaluated the learners on communication skills, crisis management algorithms, and implementation of appropriate skill sets. After each scenario, residents were debriefed on how to improve technique based on evaluation scores in areas of situational awareness, decision-making, communications and teamwork, and leadership. After the simulation, learners provided feedback on the simulation and this data was used to improve future simulations. The benefit of this cadaveric model is ease of set-up, cost-effectiveness, and reproducibility.

This protocol establishes a multidisciplinary model to train learners on management of cavernous carotid artery injury. Cadaveric heads undergo expanded endonasal approach and injury to the cavernous carotid artery, and perfusion pump simulates blood flow to the injury point. Learners are tasked with medical and surgical management over 3 scenarios.

Carotid artery injuries are serious complications of endoscopic endonasal surgery. As these occur rarely, simulation training offers an avenue for ...

Surgical Training for the Implantation of Neocortical Microelectrode Arrays Using a Formaldehyde-fixed Human Cadaver Model

This protocol describes a procedure to assist surgeons in training for the implantation of microelectrode arrays into the neocortex of the human brain. Recent technological progress has enabled the fabrication of microelectrode arrays that allow recording the activity of multiple individual neurons in the neocortex of the human brain. These arrays have the potential to bring unique insight onto the neuronal correlates of cerebral function in health and disease. Furthermore, the identification and decoding of volitional neuronal activity opens the possibility to establish brain-computer interfaces, and thus might help restore lost neurological functions. The implantation of neocortical microelectrode arrays is an invasive procedure requiring a supra-centimetric craniotomy and the exposure of the cortical surface; thus, the procedure must be performed by an adequately trained neurosurgeon. In order to provide an opportunity for surgical training, we designed a procedure based on a human cadaver model. The use of a formaldehyde-fixed human cadaver bypasses the practical, ethical and financial difficulties of surgical practice on animals (especially non-human primates) while preserving the macroscopic structure of the head, skull, meninges and cerebral surface and allowing realistic, operating room-like positioning and instrumentation. Furthermore, the use of a human cadaver is closer to clinical daily practice than any non-human model. The major drawbacks of the cadaveric simulation are the absence of cerebral pulsation and of blood and cerebrospinal fluid circulation. We suggest that a formaldehyde-fixed human cadaver model is an adequate, practical and cost-effective approach to ensure proper surgical training before implanting microelectrode arrays in the living human neocortex.

We designed a procedure in which a formaldehyde-fixed human cadaver is used to assist neurosurgeons in training for the implantation of microelectrode arrays into the neocortex of the human brain.

应用甲醛固定人尸体模型植入皮层微电极阵列的外科训练

This protocol describes a procedure to assist surgeons in training for the implantation of microelectrode arrays into the neocortex of the human brain. ...

Development of a Cadaveric Multiport Model of Posterior Circulation Aneurysm Clipping for Neurosurgery and Otolaryngology Residents

Posterior circulation aneurysms are difficult to treat with the current methods of coiling and clipping. To address limitations in training, we developed a cadaveric model to train learners on endoscopic clipping of posterior circulation aneurysms. An endoscopic transclival approach (ETA) and a transorbital precaruncular approach (TOPA) to successfully access and clip aneurysms of the posterior circulation are described. The model has flexibility in that a colored silicone compound can be injected into the cadaveric vessels for the purpose of training learners on vascular anatomy. The other option is that the model could be connected to a vascular perfusion pump allowing real-time appreciation of a pulsatile or ruptured aneurysm. This cadaveric model is the first of its kind for training of endoscopic clipping of posterior circulation aneurysms. Learners will develop proficiency in endoscopic skills, appropriate dissection, and appreciation for relative anatomy while developing an algorithm that can be employed in a real operative arena. Going forward, various clinical scenarios can be developed to enhance the realism, allow learners from different specialties to work together, and emphasize the importance of teamwork and effective communication.

A model protocol to train neurosurgery and otolaryngology resident learners on endoscopic transclival clipping of posterior circulation aneurysms is described. Two endoscopic approaches to access the silicone-injected or perfused posterior circulation of cadaveric heads are established for training. Learners are tasked with clipping of posterior circulation based on clinical scenarios.

Posterior circulation aneurysms are difficult to treat with the current methods of coiling and clipping. To address limitations in training, we developed ...

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of a robotic system. In traditional robotic training for surgeons, a brief web based overview of performing an emergency undocking is provided during initial introductory training to the robotics system. During such a process, there is no training in delineation of interdisciplinary roles for operating room (OR) personnel. The training presented here uses formative simulation and debriefing followed by a lecture. For the simulation, a modified gynecologic simulator is draped in a steep trendelenburg position consistent with most gynecologic laparoscopic surgery. The training torso is modified using tubing hooked to pressure bags of red food colored IV fluid used to simulate a catastrophic vessel injury on demand. Positioned throughout the operating room setting is an interprofessional team consisting of embedded standardized persons (ESPs) to fulfill the roles of a circulating nurse, scrub nurse, anesthesiologist, and bedside assist surgeon. Robotic surgeons are presented a case scenario necessitating emergency undocking, and given control of the robotic instruments. The scenario is terminated following either successful completion of an emergency undock, or at five minutes due to the emergent nature of the case. A debriefing session with hands on training of the steps to emergency undocking, necessary equipment, troubleshooting techniques, and operating room personnel roles follows the simulation. The learners are presented with a short lecture reemphasizing the material presented in the debriefing for their own self-study. This training results in improved time accessing the patient, improved knowledge, confidence, and completion of critical actions, and can be replicated in most institutions. All robotic surgeons should be able to demonstrate competence in this crucial intervention. A limitation of the curriculum is ability to access the in-situ environment for training purposes.

This training platform is designed to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of the robotic system. Training includes the utilization of the technology and equipment to perform an emergency undocking, as well as delineation of roles for such a scenario.

机器人手术中的紧急脱位: 一个模拟课程

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

Endoscopic endonasal surgery has gained a prominent role in the management of complex skull base tumors. It allows the resection of a large group of benign and malignant lesions through a natural anatomical extra-cranial pathway, represented by the nasal cavities, avoiding brain retraction and neurovascular manipulation. This is reflected by the patients' prompt clinical recovery and the low risk of permanent neurological sequelae, representing the main caveat of conventional skull base surgery. This surgery must be tailored to each specific case, considering its features and relationship with surrounding neural structures, mostly based on preoperative neuroimaging. Advanced MRI techniques, such as tractography, have been rarely adopted in skull base surgery due to technical issues: lengthy and complicated processes to generate reliable reconstructions for inclusion in the neuronavigation system. 
This paper aims to present the protocol implemented in the institution and highlights the synergistic collaboration and teamwork between neurosurgeons and the neuroimaging team (neurologists, neuroradiologists, neuropsychologists, physicists, and bioengineers) with the final goal of selecting the optimal treatment for each patient, improving the surgical results and pursuing the advancement of personalized medicine in this field.

We present a protocol to integrate diffusion MRI tractography in patient work-up to endoscopic endonasal surgery for a skull base tumor. The methods for adopting these neuroimaging studies in the pre- and intra-operative phases are described.

扩散MRI造影术在内窥镜内窥镜颅骨基础外科中的作用

Endoscopic endonasal surgery has gained a prominent role in the management of complex skull base tumors. It allows the resection of a large group of ...

神经科学

A Training and Testing System for Performing Vascular Reconstruction In Vitro

Manual vascular reconstruction training is essential for a beginner surgeon. However, an optimal training system for vascular reconstruction in vitro has yet to be developed. In this study, we introduce an in vitro training and testing system using a magnetic anchoring technique with which a trainee can practice manual vascular reconstruction individually. Additionally, this system can also be used to test the quality of the reconstruction. The described system includes a vascular reconstruction training machine, magnetic tractors, and a magnetic suture puller. In this manuscript, we detail an end-to-end vein anastomosis using porcine right and left iliac veins. To identify the potential damage caused by a magnetic suture puller on the suture, we created three groups with six segments of 4-0 polypropylene sutures each: a control group with no intervention on the polypropylene suture, a group in which the polypropylene suture is manually pulled with sterile gloves 20x, and a magnetic puller group in which the magnetic puller pulled the polypropylene suture 20x. These groups were tested by light microscopy and breaking strength tests, and the effect of reconstruction was assessed. In the light microscopy test, the control group was less likely to be damaged (p &#60; 0.05) and the number of damaged points of the manual group and magnetic puller group were similar (p &#62; 0.05). The results of the breaking strength test were compared across groups and no significant difference was observed (p &#62; 0.05). The end-to-end anastomosis of the porcine iliac veins was successfully performed using this training system, and the reconstructed veins could undergo 2.0 kPa perfusion pressure. Using this training and testing system the trainee can practice manual vascular reconstruction in vitro individually with the aid of magnetic tractors and a magnetic suture puller, and the quality of the reconstruction can be tested.

Here we present a training and testing system where a trainee can complete manual vascular reconstruction in vitro individually using a magnetic anchoring technique. The system can also be used to test the quality of reconstruction.

在体外进行血管重建的训练和测试系统

Manual vascular reconstruction training is essential for a beginner surgeon. However, an optimal training system for vascular reconstruction in vitro has ...

Improving Outcomes in Anteromesial Temporal Lobe Resections - A Demonstration of Resecting the Temporal Piriform Cortex

Anteromesial temporal lobe resection (ATLR) is a useful treatment option for drug-resistant mesial temporal lobe epilepsy (DRmTLE). Growing evidence suggests the piriform cortex plays a crucial role in the generation and propagation of seizures in DRmTLE - and that the resection of the temporal portion of the piriform cortex is associated with significantly improved rates of seizure freedom. 
Here, we present the resection of the temporal portion of the piriform cortex in ATLR, using high-resolution preoperative probabilistic tractography algorithms and fused anatomical masks of the structures of interest into the intraoperative neuronavigation and microscope head-up display (HUD). 
All patients undergoing comprehensive preoperative assessment and investigations for DRmTLE provided informed, written consent to record an intraoperative video of the procedure. Patients were identified by an expert multidisciplinary team of epileptologists, epilepsy neurosurgeons, neuropsychologists, neuropsychiatrists, and electrophysiologists at a large epilepsy surgery center. The preoperative imaging pipeline included the delineation of critical structures. This included the temporal piriform cortex, and high-resolution probabilistic tractography for essential tracts at risk (e.g., optic radiation and inferior fronto-occipital fasciculus). These were co-registered to the preoperative volumetric neuronavigation scan and uploaded to the intra-operative neuronavigation system. 
Presented here is a step-by-step procedure of ATLR, including the resection of the temporal portion of the piriform cortex. The protocol combines Advanced structural and diffusion MR imaging and intraoperative visual aids to integrate anatomical masks of critical grey matter structures and white matter tracts into the surgical workflow in the operating room.

Here, we demonstrate an approach to intraoperative neurosurgical guidance in anteromesial temporal lobe resections, specifically highlighting the use of tractography and anatomical masks to aid safe resection of the temporal portion of the piriform cortex - an area increasingly regarded as a crucial surgical target in drug-resistant mesial temporal lobe epilepsy.

改善前颞叶切除术的预后 - 切除颞梨状皮层的演示

Anteromesial temporal lobe resection (ATLR) is a useful treatment option for drug-resistant mesial temporal lobe epilepsy (DRmTLE). Growing evidence ...

用于微创神经介入计划的虚拟现实 3D 建模

Pioneering Patient-Specific Approaches for Precision Surgery Using Imaging and Virtual Reality

Endovascular treatment of complex vascular anomalies shifts the risk of open surgical procedures to the benefit of minimally invasive endovascular procedural solutions. Complex open surgical procedures used to be the only option for the treatment of a myriad of conditions like pulmonary and aortic valve replacement as well as cerebral aneurysm repair. However, due to advancements in catheter-delivered devices and operator expertise, these procedures (along with many others) can now be performed through minimally invasive procedures delivered through a central or peripheral vein or artery. The decision to shift from an open procedure to an endovascular approach is based on multi-modal imaging, often including 3D Digital Imaging and Communications in Medicine (DICOM) imaging datasets. Utilizing these 3D images, our lab generates 3D models of the pathologic anatomy, thereby allowing the pre-procedural analysis necessary to pre-plan critical components of the catheterization lab procedure, namely, C-arm positioning, 3D measurement, and idealized road-map generation. This article describes how to take segmented 3D models of patient-specific pathology and predict generalized C-arm positions, how to measure critical two-dimensional (2D) measurements of 3D structures relevant to the 2D fluoroscopy projections, and how to generate 2D fluoroscopy roadmap analogs that can assist in proper C-arm positioning during catheterization lab procedures.

作者聚焦：用于高级神经血管介入的分割和 VR

Advancements in endovascular treatment have replaced complex open surgical procedures with minimally invasive options, like valve replacement and aneurysm repair. This paper proposes using three-dimensional (3D) modeling and virtual reality to aid in C-arm positioning, angle measurements, and roadmap generation for neuro-interventional catheterization lab procedural planning, minimizing procedure time.