Name: simulator training for endovascular neurosurgery
Uploaded: 2020-05-06T12:30:00
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?...

<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>

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 ...

Research

JoVE Journal

Neuroscience

Focal Cerebral Ischemia Model by Endovascular Suture Occlusion of the Middle Cerebral Artery in the Rat

焦距脑缺血模型大鼠大脑中动脉的血管内缝合闭塞

Stroke is the leading cause of disability and the third leading cause of death in adults worldwide1. In human stroke, there exists a highly variable ...

科研

神经科学

MPI CyberMotion Simulator: Implementation of a Novel Motion Simulator to Investigate Multisensory Path Integration in Three Dimensions

MPI Cyber​​Motion模拟器：一种新型的运动模拟器的执行情况调查三个维度的多感官的路径积分

Path integration is a process in which self-motion is integrated over time to obtain an estimate of one's current position relative to a starting point 1. ...

Extinction Training During the Reconsolidation Window Prevents Recovery of Fear

灭绝培训在彭兰霞窗口无法还原的恐惧

Fear is maladaptive when it persists long after circumstances have become safe. It is therefore crucial to develop an approach that persistently prevents ...

Production and Isolation of Axons from Sensory Neurons for Biochemical Analysis Using Porous Filters

生产和轴突隔离从感觉神经元的生化分析使用多孔过滤器

Neuronal axons use specific mechanisms to mediate extension, maintain integrity, and induce degeneration. An appropriate balance of these events is ...

Long-term Continuous EEG Monitoring in Small Rodent Models of Human Disease Using the Epoch Wireless Transmitter System

在人类疾病中使用大纪元无线传输系统的小型啮齿动物模型的长期连续监测脑电图

Many progressive neurologic diseases in humans, such as epilepsy, require pre-clinical animal models that slowly develop the disease in order to test ...

Exposure of the Pig CNS for Histological Analysis: A Manual for Decapitation, Skull Opening, and Brain Removal

猪中枢神经系统的组织学分析的曝光：一个手册斩首，颅骨打开，并去除脑

Pigs have become increasingly popular in large-animal translational neuroscience research as an economically and ethically feasible substitute to ...

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

脑动静脉畸形的综合血管内和开放性手术治疗

Arteriovenious malformations (AVMs) are associated with significant morbidity and mortality, and have a rupture risk of ~3% per year. Treatment of AVMs ...

A Protocol for the Administration of Real-Time fMRI Neurofeedback Training

实时 fMRI 神经训练管理协议

Neurologic disorders are characterized by abnormal cellular-, molecular-, and circuit-level functions in the brain. New methods to induce and control ...

Fiber Connections of the Supplementary Motor Area Revisited: Methodology of Fiber Dissection, DTI, and Three Dimensional Documentation

补充电机区的光纤连接重新审视：光纤解剖，DTI和三维文档的方法

The purpose of this study is to show the methodology for the examination of the white matter connections of the supplementary motor area (SMA) complex ...

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

内镜下鼻跨蝶入路: 垂体腺瘤的微创手术

Endoscopic endonasal trans-sphenoidal surgery has become the gold standard for the surgical treatment of pituitary adenomas and many other pituitary ...