Abstract
Background:
Over the last decade, neuroendoscopy has re-emerged as an interesting option in the
management of intraventricular lesions in both children and adults. Nonetheless, as
it has become more difficult to use cadaveric specimens in training, the development
of alternative methods was vital. The aim of this study was to analyze the performance
of a real simulator, in association with image-guided navigation, as a teaching tool
for the training of intraventricular endoscopic procedures.
Methods:
3 real simulators were built using a special type of resin. 1 was designed to represent
the abnormally enlarged ventricles, making it possible for a third ventriculostomy
to be performed. The remaining 2 were designed to simulate a person’s skull and brain
bearing intraventricular lesions, which were placed as follows: in the foramen of
Monro region, in the frontal and occipital horns of the lateral ventricles and within
the third ventricle. In all models, MRI images were obtained for navigation guidance.
Within the ventricles, the relevant anatomic structures and the lesions were identified
through the endoscope and compared with the position given by the navigation device.
The next step consisted of manipulating the lesions, using standard endoscopic techniques.
Results:
We observed that the models were MRI compatible, easy and safe to handle. They nicely
reproduced the intraventricular anatomy and brain consistence, as well as simulated
intraventricular lesions. The image-based navigation was efficient in guiding the
surgeon through the endoscopic procedure, allowing the selection of the best approach
as well as defining the relevant surgical landmarks for each ventricular compartment.
Nonetheless, as expected, navigation inaccuracies occurred. After the training sessions
the surgeons felt they had gained valued experience by dealing with intraventricular
lesions employing endoscopic techniques.
Conclusion:
The use of real simulators in association with image-guided navigation proved to be
an effective tool in training for neuroendoscopy.
Key words
brain model - neuroendoscopy - intraventricular procedures - training - neuronavigation
