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de Divitiis O, d'Avella E, Fabozzi GL, Cavallo LM, Solari D. Surgeon's Eyes on the Relevant Surgical Target. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:5-11. [PMID: 38153441 DOI: 10.1007/978-3-031-36084-8_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
The resolution of the naked eye has been a challenge for the neurosurgical endeavor since the very first attempts of cranial surgery, and advances have been achieved over the centuries, driven by a synergism between the application of emerging technology into the surgical environment and the expansion of the capabilities of neurosurgery. The understanding of the principles of the optical properties of lenses by Abbè (1840-1905) led to the introduction of loupes in the surgical practice, increasing the visual performance during macroscopic procedures. Modern neurosurgery began with the possibility of illumination and magnification of the surgical field as provided by the microscope. Pioneering contributions from Donaghy and Yasargil opened the way to the era of minimalism with reduction of operative corridors and surgical trauma through the adoption of the microsurgical technique. Almost at the same time, engineering mirabilia of Hopkins in terms of optics and lenses allowed for introduction of rigid and flexible endoscopes as a viable tool in neurosurgery. Nowadays, neurosurgeons are aware of and confident using effective and modern tools of visualization in their armamentarium. Herein we present a cogent review of the evolution of visualization tools in neurosurgery, with a special glimpse into the current development and future achievements.
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Affiliation(s)
- Oreste de Divitiis
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy.
| | - Elena d'Avella
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Gianluca Lorenzo Fabozzi
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
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2
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Durrani S, Onyedimma C, Jarrah R, Bhatti A, Nathani KR, Bhandarkar AR, Mualem W, Ghaith AK, Zamanian C, Michalopoulos GD, Alexander AY, Jean W, Bydon M. The Virtual Vision of Neurosurgery: How Augmented Reality and Virtual Reality are Transforming the Neurosurgical Operating Room. World Neurosurg 2022; 168:190-201. [DOI: 10.1016/j.wneu.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/22/2022]
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3
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Mishra R, Narayanan MK, Umana GE, Montemurro N, Chaurasia B, Deora H. Virtual Reality in Neurosurgery: Beyond Neurosurgical Planning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031719. [PMID: 35162742 PMCID: PMC8835688 DOI: 10.3390/ijerph19031719] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/29/2022] [Accepted: 01/30/2022] [Indexed: 02/04/2023]
Abstract
Background: While several publications have focused on the intuitive role of augmented reality (AR) and virtual reality (VR) in neurosurgical planning, the aim of this review was to explore other avenues, where these technologies have significant utility and applicability. Methods: This review was conducted by searching PubMed, PubMed Central, Google Scholar, the Scopus database, the Web of Science Core Collection database, and the SciELO citation index, from 1989–2021. An example of a search strategy used in PubMed Central is: “Virtual reality” [All Fields] AND (“neurosurgical procedures” [MeSH Terms] OR (“neurosurgical” [All Fields] AND “procedures” [All Fields]) OR “neurosurgical procedures” [All Fields] OR “neurosurgery” [All Fields] OR “neurosurgery” [MeSH Terms]). Using this search strategy, we identified 487 (PubMed), 1097 (PubMed Central), and 275 citations (Web of Science Core Collection database). Results: Articles were found and reviewed showing numerous applications of VR/AR in neurosurgery. These applications included their utility as a supplement and augment for neuronavigation in the fields of diagnosis for complex vascular interventions, spine deformity correction, resident training, procedural practice, pain management, and rehabilitation of neurosurgical patients. These technologies have also shown promise in other area of neurosurgery, such as consent taking, training of ancillary personnel, and improving patient comfort during procedures, as well as a tool for training neurosurgeons in other advancements in the field, such as robotic neurosurgery. Conclusions: We present the first review of the immense possibilities of VR in neurosurgery, beyond merely planning for surgical procedures. The importance of VR and AR, especially in “social distancing” in neurosurgery training, for economically disadvantaged sections, for prevention of medicolegal claims and in pain management and rehabilitation, is promising and warrants further research.
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Affiliation(s)
- Rakesh Mishra
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India;
| | | | - Giuseppe E. Umana
- Trauma and Gamma-Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95100 Catania, Italy;
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy
- Correspondence:
| | - Bipin Chaurasia
- Department of Neurosurgery, Bhawani Hospital, Birgunj 44300, Nepal;
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India;
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El Refaee E, Zohdi A, Schroeder HWS. In Reply: A New Trend of Blended Learning in Neurosurgical Training: Fellowship of Neuroendoscopy. Neurosurgery 2022; 90:e57. [PMID: 34995244 DOI: 10.1227/neu.0000000000001807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 12/25/2022] Open
Affiliation(s)
- Ehab El Refaee
- Department of Neurosurgery, Cairo University, Cairo, Egypt
- Department of Neurosurgery, University Medicine Greifswald, Griefswald, Germany
| | - Ahmed Zohdi
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Griefswald, Germany
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Zagzoog N, Zadeh G, Lin V, Yang VXD. Perspective review on applications of optics in skull base surgery. Clin Neurol Neurosurg 2021; 212:107085. [PMID: 34894572 DOI: 10.1016/j.clineuro.2021.107085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/19/2022]
Abstract
The use of optic technology in skull base surgeries has the potential to revolutionize the field of medicine, particularly neurosurgery and neurology. Here, we briefly present the past, present, and future of skull-base surgery, with an emphasis on the applications of optical topography techniques. We discuss optical topography techniques such as functional near-infrared spectroscopy, optical diffusion tomography, and optical topographical imaging. Optical topography techniques are particularly advantageous when combined with other imaging methods. For instance, optical topography can be combined with techniques such as functional magnetic resonance imaging (fMRI) to combine the temporal resolution of optical topography with the spatial resolution of fMRI. Multimodal approaches will be critical to advance brain-related research as well as medicine. Structured light imaging techniques are also writing the future of 3-dimensional imaging. In short, optical topography can allow for non-invasive, high-resolution imaging that will provide real-time visualizations of the brain that are ideal for neurosurgery. From the limitations of traditional skull base surgeries to the newest developments in optical neuroimaging, here we will discuss the potential applications of optics in skull base procedures.
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Affiliation(s)
- Nirmeen Zagzoog
- Institute of Medical Science, School of Graduate Studies, Faculty of Medicine, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Vincent Lin
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Victor X D Yang
- Sunnybrook Health Sciences Centre, Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Ryerson University, Bioengineering and Biophotonics Laboratory, Toronto, Ontario, Canada
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Liounakos JI, Chenin L, Theodore N, Wang MY. Robotics in Spine Surgery and Spine Surgery Training. Oper Neurosurg (Hagerstown) 2021; 21:35-40. [PMID: 34017989 DOI: 10.1093/ons/opaa449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/23/2020] [Indexed: 01/06/2023] Open
Abstract
The increasing interest and advancements in robotic spine surgery parallels a growing emphasis on maximizing patient safety and outcomes. In addition, an increasing interest in minimally invasive spine surgery has further fueled robotic development, as robotic guidance systems are aptly suited for these procedures. This review aims to address 3 of the most critical aspects of robotics in spine surgery today: salient details regarding the current and future development of robotic systems and functionalities, the reported accuracy of implant placement over the years, and how the implementation of robotic systems will impact the training of future generations of spine surgeons. As current systems establish themselves as highly accurate tools for implant placement, the development of novel features, including even robotic-assisted decompression, will likely occur. As spine surgery robots evolve and become increasingly adopted, it is likely that resident and fellow education will follow suit, leading to unique opportunities for both established surgeons and trainees.
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Affiliation(s)
- Jason I Liounakos
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Louis Chenin
- Department of Neurosurgery, Amiens University Hospital, Avenue René Laënnec, Salouël, Amiens Cedex 1, France
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Chidambaram S, Stifano V, Demetres M, Teyssandier M, Palumbo MC, Redaelli A, Olivi A, Apuzzo MLJ, Pannullo SC. Applications of augmented reality in the neurosurgical operating room: A systematic review of the literature. J Clin Neurosci 2021; 91:43-61. [PMID: 34373059 DOI: 10.1016/j.jocn.2021.06.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/15/2022]
Abstract
Advancements in imaging techniques are key forces of progress in neurosurgery. The importance of accurate visualization of intraoperative anatomy cannot be overemphasized and is commonly delivered through traditional neuronavigation. Augmented Reality (AR) technology has been tested and applied widely in various neurosurgical subspecialties in intraoperative, clinical use and shows promise for the future. This systematic review of the literature explores the ways in which AR technology has been successfully brought into the operating room (OR) and incorporated into clinical practice. A comprehensive literature search was performed in the following databases from inception-April 2020: Ovid MEDLINE, Ovid EMBASE, and The Cochrane Library. Studies retrieved were then screened for eligibility against predefined inclusion/exclusion criteria. A total of 54 articles were included in this systematic review. The studies were sub- grouped into brain and spine subspecialties and analyzed for their incorporation of AR in the neurosurgical clinical setting. AR technology has the potential to greatly enhance intraoperative visualization and guidance in neurosurgery beyond the traditional neuronavigation systems. However, there are several key challenges to scaling the use of this technology and bringing it into standard operative practice including accurate and efficient brain segmentation of magnetic resonance imaging (MRI) scans, accounting for brain shift, reducing coregistration errors, and improving the AR device hardware. There is also an exciting potential for future work combining AR with multimodal imaging techniques and artificial intelligence to further enhance its impact in neurosurgery.
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Affiliation(s)
| | - Vito Stifano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University, Rome, Italy
| | - Michelle Demetres
- Samuel J. Wood & C.V. Starr Biomedical Information Center, Weill Cornell Medical, College/New York Presbyterian Hospital, New York, NY, USA
| | | | - Maria Chiara Palumbo
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University, Rome, Italy
| | | | - Susan C Pannullo
- Department of Neurosurgery, Weill Cornell Medical College, NY, USA.
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8
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Iizuka K, Sato Y, Imaizumi Y, Mizutani T. Potential Efficacy of Multimodal Mixed Reality in Epilepsy Surgery. Oper Neurosurg (Hagerstown) 2021; 20:276-281. [PMID: 33382064 DOI: 10.1093/ons/opaa341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/25/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mixed reality (MR) technology, which can fuse things in real and virtual space in real time, has been used mainly for simulation in neurosurgical training. OBJECTIVE To develop MR technology into multimodal MR for intraoperative guidance during epilepsy surgery. METHODS A 33-yr-old male patient suffered from intractable general tonic seizures due to left temporal meningoencephalocele. Preoperative scalp electroencephalograms localized interictal epileptic activity on the left temporal lobe. Iomazenil single photon emission tomography revealed temporal lobe lateralization. Magnetic resonance imaging (MRI) demonstrated left basal temporal meningoencephalocele extending into the pterygopalatine fossa through a bone defect at the base of the greater sphenoid wing. A 3-dimensional model was created for MR based on multimodal data including computed tomography, MRI tractography, and digital subtraction angiography, which enabled 3-dimensional visualization of abnormal subcortical fiber connections between the meningoencephalocele and the epileptic focus. RESULTS By using intraoperative multimodal MR, we were able to safely remove the meningoencephalocele and perform epileptic focus resection. The patient was seizure-free postoperatively, and no adverse effects were noted. CONCLUSION Intraoperative multimodal MR was a feasible and effective technique, and it can be applied for a wide range of epilepsy surgeries.
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Affiliation(s)
- Kazuki Iizuka
- Department of Neurosurgery, AOI Universal Hospital, Kawasaki, Kanagawa, Japan.,Department of Neurosurgery, Showa University of Medicine, Shinagawa, Tokyo, Japan
| | - Yosuke Sato
- Department of Neurosurgery, Showa University of Medicine, Shinagawa, Tokyo, Japan
| | - Yohichi Imaizumi
- Department of Neurosurgery, AOI Universal Hospital, Kawasaki, Kanagawa, Japan.,Department of Neurosurgery, Showa University of Medicine, Shinagawa, Tokyo, Japan
| | - Tohru Mizutani
- Department of Neurosurgery, Showa University of Medicine, Shinagawa, Tokyo, Japan
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9
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Delgado-Fernández J, Frade-Porto N, Blasco G, Gonzalez-Tarno P, Gil-Simoes R, Pulido P, Sola RG. Simulation with 3D Neuronavigation for Learning Cortical Bone Trajectory Screw Placement. J Neurol Surg A Cent Eur Neurosurg 2020; 82:262-269. [PMID: 33260245 DOI: 10.1055/s-0040-1715485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Learning a new technique in neurosurgery is a big challenge especially for trainees. In recent years, simulations and simulators got into the focus as a teaching tool. Our objective is to propose a simulator for placement of cortical bone trajectory (CBT) screws to improve results and reduce complications. METHODS We have created a platform consisting of a sawbone navigated with a 3D fluoroscope to familiarize our trainees and consultants with CBT technique and later implement it in our department. Objective Structured Assessment of Technical Skills (OSATS) and Physician Performance Diagnostic Inventory Scale (PPDI) were obtained before and after the use of the simulator by the five participants in the study. Patients who were operated on after the implementation of the technique were retrospectively reviewed. RESULTS During the simulation, there were 4 cases of pedicle breach out of 24 screws inserted (16.6%). After having completed simulation, participants demonstrated an improvement in OSATS and PPDI (p = 0.039 and 0.042, respectively). Analyzing the answers to the different items of the tests, participants mainly improved in the knowledge (p = 0.038), the performance (p = 0.041), and understanding of the procedure (p = 0.034). In our retrospective series, eight patients with L4-L5 instability were operated on using CBT, improving their Oswestry Disability Index (ODI) score (preoperative ODI 58.5 [SD 16.7] vs. postoperative ODI 31 [SD 13.4]; p = 0.028). One intraoperative complication due to a dural tear was observed. In the follow-up, we found a case of pseudoarthrosis and a facet joint violation, but no other complications related to misplacement, pedicle fracture, or hardware failure. CONCLUSION The simulation we have created is useful for the implementation of CBT. In our study, consultants and trainees have valued very positively the learning obtained using the system. Moreover, simulation facilitated the learning of the technique and the understanding of surgical anatomy. We hope that simulation helps reducing complications in the future.
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Affiliation(s)
| | | | - Guillermo Blasco
- Division of Neurosurgery, University Hospital La Princesa, Madrid, Spain
| | | | - Ricardo Gil-Simoes
- Division of Neurosurgery, University Hospital La Princesa, Madrid, Spain
| | - Paloma Pulido
- Division of Neurosurgery, University Hospital La Princesa, Madrid, Spain
| | - R G Sola
- Department of Innovation in Neurosurgery, Universidad Autónoma de Madrid, Madrid, Spain.,Neurosurgical Department Hospital Nuestra Señora del Rosario, Madrid, Spain
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Tomlinson SB, Hendricks BK, Cohen-Gadol A. Immersive Three-Dimensional Modeling and Virtual Reality for Enhanced Visualization of Operative Neurosurgical Anatomy. World Neurosurg 2019; 131:313-320. [DOI: 10.1016/j.wneu.2019.06.081] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/07/2019] [Indexed: 01/17/2023]
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11
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Kubben PL, Sinlae RSN. Feasibility of using a low-cost head-mounted augmented reality device in the operating room. Surg Neurol Int 2019; 10:26. [PMID: 31123633 PMCID: PMC6416754 DOI: 10.4103/sni.sni_228_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 12/13/2018] [Indexed: 12/01/2022] Open
Abstract
Background: Augmented reality (AR) has great potential for improving image-guided neurosurgical procedures, but until recently, hardware was mostly custom-made and difficult to distribute. Currently, commercially available low-cost AR devices offer great potential for neurosurgery, but reports on technical feasibility are lacking. The goal of this pilot study is to evaluate the feasibility of using a low-cost commercially available head-mounted holographic AR device (the Microsoft Hololens) in the operating room. The Hololens is operated by performing specific hand gestures, which are recognized by the built-in camera of the device. This would allow the neurosurgeon to control the device “touch free” even while wearing a sterile surgical outfit. Methods: The Hololens was tested in an operating room under two lighting conditions (general background theatre lighting only; and general background theatre lighting and operating lights) and wearing different surgical gloves (both bright and dark). All required hand gestures were performed, and voice recognition was evaluated against background noise consisting of two nurses talking at conversational speech level. Results: Wearing comfort was sufficient, with and without regular glasses. All gestures were correctly classified regardless of lighting conditions or the sort of sterile gloves. Voice recognition was good. The visibility of the holograms was good if the device was configured to use high brightness for display. Conclusions: We demonstrate that using a commercially available low-cost head-mounted holographic AR device is feasible in a sterile surgical setting, under different lighting conditions and using different surgical gloves. Given the availability of freely available software for application development, neurosurgery can benefit from new opportunities for image-guided surgery.
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Affiliation(s)
- Pieter L Kubben
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Medical Information Technology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Remir S N Sinlae
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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12
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Lee C, Wong GKC. Virtual reality and augmented reality in the management of intracranial tumors: A review. J Clin Neurosci 2019; 62:14-20. [PMID: 30642663 DOI: 10.1016/j.jocn.2018.12.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/22/2018] [Indexed: 01/19/2023]
Abstract
Neurosurgeons are faced with the challenge of planning, performing, and learning complex surgical procedures. With improvements in computational power and advances in visual and haptic display technologies, augmented and virtual surgical environments can offer potential benefits for tests in a safe and simulated setting, as well as improve management of real-life procedures. This systematic literature review is conducted in order to investigate the roles of such advanced computing technology in neurosurgery subspecialization of intracranial tumor removal. The study would focus on an in-depth discussion on the role of virtual reality and augmented reality in the management of intracranial tumors: the current status, foreseeable challenges, and future developments.
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Affiliation(s)
- Chester Lee
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - George Kwok Chu Wong
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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13
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Yoon JW, Chen RE, Kim EJ, Akinduro OO, Kerezoudis P, Han PK, Si P, Freeman WD, Diaz RJ, Komotar RJ, Pirris SM, Brown BL, Bydon M, Wang MY, Wharen RE, Quinones-Hinojosa A. Augmented reality for the surgeon: Systematic review. Int J Med Robot 2018; 14:e1914. [DOI: 10.1002/rcs.1914] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Jang W. Yoon
- Department of Neurological Surgery; Mayo Clinic; Jacksonville Florida USA
| | - Robert E. Chen
- Emory University School of Medicine; Atlanta Georgia USA
- Georgia Institute of Technology; Atlanta Georgia USA
| | | | | | | | | | - Phong Si
- Georgia Institute of Technology; Atlanta Georgia USA
| | | | - Roberto J. Diaz
- Department of Neurosurgery and Neurology; Montreal Neurological Institute and Hospital, McGill University; Montreal Quebec Canada
| | - Ricardo J. Komotar
- Department of Neurological Surgery; University of Miami Miller School of Medicine, University of Miami Hospital, University of Miami Brain Tumor Initiative; Miami Florida USA
| | - Stephen M. Pirris
- Department of Neurological Surgery; Mayo Clinic; Jacksonville Florida USA
- St. Vincent's Spine and Brain Institute; Jacksonville Florida USA
| | - Benjamin L. Brown
- Department of Neurological Surgery; Mayo Clinic; Jacksonville Florida USA
| | - Mohamad Bydon
- Department of Neurological Surgery; Mayo Clinic; Rochester Minnesota USA
| | - Michael Y. Wang
- Department of Neurological Surgery; University of Miami Miller School of Medicine, University of Miami Hospital, University of Miami Brain Tumor Initiative; Miami Florida USA
| | - Robert E. Wharen
- Department of Neurological Surgery; Mayo Clinic; Jacksonville Florida USA
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Abstract
Recent biotechnological advances, including three-dimensional microscopy and endoscopy, virtual reality, surgical simulation, surgical robotics, and advanced neuroimaging, have continued to mold the surgeon-computer relationship. For developing neurosurgeons, such tools can reduce the learning curve, improve conceptual understanding of complex anatomy, and enhance visuospatial skills. We explore the current and future roles and application of virtual reality and simulation in neurosurgical training.
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Pelargos PE, Nagasawa DT, Lagman C, Tenn S, Demos JV, Lee SJ, Bui TT, Barnette NE, Bhatt NS, Ung N, Bari A, Martin NA, Yang I. Utilizing virtual and augmented reality for educational and clinical enhancements in neurosurgery. J Clin Neurosci 2016; 35:1-4. [PMID: 28137372 DOI: 10.1016/j.jocn.2016.09.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/12/2016] [Indexed: 01/16/2023]
Abstract
Neurosurgery has undergone a technological revolution over the past several decades, from trephination to image-guided navigation. Advancements in virtual reality (VR) and augmented reality (AR) represent some of the newest modalities being integrated into neurosurgical practice and resident education. In this review, we present a historical perspective of the development of VR and AR technologies, analyze its current uses, and discuss its emerging applications in the field of neurosurgery.
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Affiliation(s)
- Panayiotis E Pelargos
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Daniel T Nagasawa
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Carlito Lagman
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Stephen Tenn
- Department of Radiation Oncology, University of California, Los Angeles, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA 90095-6951, United States
| | - Joanna V Demos
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Seung J Lee
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Timothy T Bui
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Natalie E Barnette
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Nikhilesh S Bhatt
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Nolan Ung
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Ausaf Bari
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Neil A Martin
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States.
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Farahani N, Post R, Duboy J, Ahmed I, Kolowitz BJ, Krinchai T, Monaco SE, Fine JL, Hartman DJ, Pantanowitz L. Exploring virtual reality technology and the Oculus Rift for the examination of digital pathology slides. J Pathol Inform 2016; 7:22. [PMID: 27217972 PMCID: PMC4872484 DOI: 10.4103/2153-3539.181766] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/03/2016] [Indexed: 12/12/2022] Open
Abstract
Background: Digital slides obtained from whole slide imaging (WSI) platforms are typically viewed in two dimensions using desktop personal computer monitors or more recently on mobile devices. To the best of our knowledge, we are not aware of any studies viewing digital pathology slides in a virtual reality (VR) environment. VR technology enables users to be artificially immersed in and interact with a computer-simulated world. Oculus Rift is among the world's first consumer-targeted VR headsets, intended primarily for enhanced gaming. Our aim was to explore the use of the Oculus Rift for examining digital pathology slides in a VR environment. Methods: An Oculus Rift Development Kit 2 (DK2) was connected to a 64-bit computer running Virtual Desktop software. Glass slides from twenty randomly selected lymph node cases (ten with benign and ten malignant diagnoses) were digitized using a WSI scanner. Three pathologists reviewed these digital slides on a 27-inch 5K display and with the Oculus Rift after a 2-week washout period. Recorded endpoints included concordance of final diagnoses and time required to examine slides. The pathologists also rated their ease of navigation, image quality, and diagnostic confidence for both modalities. Results: There was 90% diagnostic concordance when reviewing WSI using a 5K display and Oculus Rift. The time required to examine digital pathology slides on the 5K display averaged 39 s (range 10–120 s), compared to 62 s with the Oculus Rift (range 15–270 s). All pathologists confirmed that digital pathology slides were easily viewable in a VR environment. The ratings for image quality and diagnostic confidence were higher when using the 5K display. Conclusion: Using the Oculus Rift DK2 to view and navigate pathology whole slide images in a virtual environment is feasible for diagnostic purposes. However, image resolution using the Oculus Rift device was limited. Interactive VR technologies such as the Oculus Rift are novel tools that may be of use in digital pathology.
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Affiliation(s)
- Navid Farahani
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Robert Post
- Information Services Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jon Duboy
- Information Services Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ishtiaque Ahmed
- Information Services Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brian J Kolowitz
- Enterprises Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Teppituk Krinchai
- Enterprises Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jeffrey L Fine
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Douglas J Hartman
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Wanibuchi M, Noshiro S, Sugino T, Akiyama Y, Mikami T, Iihoshi S, Miyata K, Komatsu K, Mikuni N. Training for Skull Base Surgery with a Colored Temporal Bone Model Created by Three-Dimensional Printing Technology. World Neurosurg 2016; 91:66-72. [PMID: 27062915 DOI: 10.1016/j.wneu.2016.03.084] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE A 3-dimensional temporal bone model for skull base surgical training was reconstructed via the use of a selective laser sintering technique, which is one of the 3-dimensional printing technologies. METHODS The temporal bone model was created in 2 pieces to remove powder material in the mastoid air cells and to place dye into the semicircular canal and the Fallopian canal. RESULTS The powder material was minimal, and the decisive structures were identified in color. CONCLUSIONS This artificial model will pave the way to a "new era" in surgical training and medical education.
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Affiliation(s)
- Masahiko Wanibuchi
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shouhei Noshiro
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiya Sugino
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Iihoshi
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kei Miyata
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Katsuya Komatsu
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
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18
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Alaraj A, Luciano CJ, Bailey DP, Elsenousi A, Roitberg BZ, Bernardo A, Banerjee PP, Charbel FT. Virtual reality cerebral aneurysm clipping simulation with real-time haptic feedback. Neurosurgery 2015; 11 Suppl 2:52-8. [PMID: 25599200 DOI: 10.1227/neu.0000000000000583] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND With the decrease in the number of cerebral aneurysms treated surgically and the increase of complexity of those treated surgically, there is a need for simulation-based tools to teach future neurosurgeons the operative techniques of aneurysm clipping. OBJECTIVE To develop and evaluate the usefulness of a new haptic-based virtual reality simulator in the training of neurosurgical residents. METHODS A real-time sensory haptic feedback virtual reality aneurysm clipping simulator was developed using the ImmersiveTouch platform. A prototype middle cerebral artery aneurysm simulation was created from a computed tomographic angiogram. Aneurysm and vessel volume deformation and haptic feedback are provided in a 3-dimensional immersive virtual reality environment. Intraoperative aneurysm rupture was also simulated. Seventeen neurosurgery residents from 3 residency programs tested the simulator and provided feedback on its usefulness and resemblance to real aneurysm clipping surgery. RESULTS Residents thought that the simulation would be useful in preparing for real-life surgery. About two-thirds of the residents thought that the 3-dimensional immersive anatomic details provided a close resemblance to real operative anatomy and accurate guidance for deciding surgical approaches. They thought the simulation was useful for preoperative surgical rehearsal and neurosurgical training. A third of the residents thought that the technology in its current form provided realistic haptic feedback for aneurysm surgery. CONCLUSION Neurosurgical residents thought that the novel immersive VR simulator is helpful in their training, especially because they do not get a chance to perform aneurysm clippings until late in their residency programs.
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Affiliation(s)
- Ali Alaraj
- *Department of Neurosurgery, University of Illinois College of Medicine at Chicago, Chicago, Illinois; ‡Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, Illinois; §ImmersiveTouch, Inc., Westmont, Illinois; ¶College of Engineering, University of Illinois at Chicago, Chicago, Illinois; ‖Division of Neurosurgery, Department of Surgery, University of Chicago, Chicago, Illinois; and #Department of Neurosurgery, Weill Cornell Medical College, New York
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19
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Krishnaney AA. Incorporating Simulators Into Neurosurgical Education. World Neurosurg 2015; 84:1527-9. [PMID: 26189666 DOI: 10.1016/j.wneu.2015.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/08/2015] [Indexed: 01/22/2023]
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20
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Endoscopic endonasal surgery for pituitary adenomas. World Neurosurg 2015; 82:S3-11. [PMID: 25496632 DOI: 10.1016/j.wneu.2014.07.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 07/25/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pituitary surgery is a continuous evolving specialty of the neurosurgeons' armamentarium, which requires precise anatomic knowledge, technical skills, and integrated culture of the pituitary pathophysiology. Actually it cannot be considered only from a technical standpoint, but rather a procedure resulting from the close cooperation among different specialists (e.g., ophthalmologists, neuroradiologists, endocrinologists, neurosurgeons, otorhinolaryngologists, anesthesiologists, neurophysiologists, pathologists, instrument manufacturers). METHODS The "pure" endoscopic endonsal surgery is a procedure performed through the nose, with the endoscope alone throughout the whole approach and without any transsphenoidal retractor. The procedure consists of three main aspects: exposure of the lesion, removal of the relevant pathology, and reconstruction, going through three different steps, the nasal, the sphenoid, and the sellar phases. CONCLUSIONS The endoscopic approach offers some advantages due to the endoscope itself: a superior close-up view of the relevant anatomy and an enlarged working angle are provided with an increased panoramic vision inside the surgical area. Concerning results in terms of mass removal, relief of clinical symptoms, cure of the underlying disease, and complication rate, these are, at least, similar to those reported in the major microsurgical series, but patient compliance is by far better. Besides the advantages to the patients, the surgeons-because of the wider and closer view of the surgical target area and the increase of the scientific activity as from the peer-reviewed literature on the topic in the past 10 years, the smoothing of interdisciplinary cooperation-, and the institutions (shorter postoperative hospital stay and increase of the case load)- the adoption of endoscopy in transsphenoidal surgery has gained a strong foothold.
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21
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Aoun SG, El Ahmadieh TY, El Tecle NE, Daou MR, Adel JG, Park CS, Batjer HH, Bendok BR. A pilot study to assess the construct and face validity of the Northwestern Objective Microanastomosis Assessment Tool. J Neurosurg 2015; 123:103-9. [PMID: 25658787 DOI: 10.3171/2014.12.jns131814] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Microsurgical skills remain an integral component of neurosurgical education. There is a need for an objective scale to assess microsurgical skills. The objective of this study was to assess the face and construct validity of a bench training microanastomosis module and an objective assessment scale, i.e., the Northwestern Objective Microanastomosis Assessment Tool (NOMAT). METHODS Medical students, neurosurgical residents, and postdoctoral research fellows at Northwestern University were enrolled in the study. Trainees were divided into 3 groups based on microsurgical experience: 1) experienced, 2) exposed, and 3) novices. Each trainee completed two end-to-end microanastomoses using a 1-mm and a 3-mm synthetic vessel. Two cameras were installed to capture procedural footage. One neurosurgeon blindly graded the performance of trainees using both objective and subjective methods to assess construct validity. Two neurosurgeons reviewed the contents of the simulation module to assess face validity. RESULTS Twenty-one trainees participated in the study, including 6 experienced, 6 exposed, and 9 novices. The mean NOMAT score for experienced trainees on the 1-mm module was 47.3/70 compared with 26.0/70 and 25.8/70 for exposed and novice trainees, respectively (p = 0.02). Using subjective grading, experienced trainees performed significantly better on the 1-mm module (64.2/100) compared with exposed or novice trainees (23.3/100 and 25.0/100, respectively; p = 0.02). No statistical difference between groups was noted for the 3-mm module with both NOMAT and subjective grading. Experienced trainees took less time to perform both tasks compared with the others. CONCLUSIONS Face and construct validities of the microanastomosis module were established. The scale and the microanastomosis module could help assess the microsurgical skills of neurosurgical trainees and serve as a basis for the creation of a microsurgical curriculum.
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Affiliation(s)
- Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas; and
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas; and
| | | | | | | | | | - H Hunt Batjer
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas; and
| | - Bernard R Bendok
- Departments of 2 Neurological Surgery.,Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Suebnukarn S, Chaisombat M, Kongpunwijit T, Rhienmora P. Construct Validity and Expert Benchmarking of the Haptic Virtual Reality Dental Simulator. J Dent Educ 2014. [DOI: 10.1002/j.0022-0337.2014.78.10.tb05818.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Hooten KG, Lister JR, Lombard G, Lizdas DE, Lampotang S, Rajon DA, Bova F, Murad GJ. Mixed Reality Ventriculostomy Simulation: Experience in Neurosurgical Residency. Oper Neurosurg (Hagerstown) 2014; 10 Suppl 4:576-81; discussion 581. [DOI: 10.1227/neu.0000000000000503] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Medicine and surgery are turning toward simulation to improve on limited patient interaction during residency training. Many simulators today use virtual reality with augmented haptic feedback with little to no physical elements. In a collaborative effort, the University of Florida Department of Neurosurgery and the Center for Safety, Simulation & Advanced Learning Technologies created a novel “mixed” physical and virtual simulator to mimic the ventriculostomy procedure. The simulator contains all the physical components encountered for the procedure with superimposed 3-D virtual elements for the neuroanatomical structures.
OBJECTIVE:
To introduce the ventriculostomy simulator and its validation as a necessary training tool in neurosurgical residency.
METHODS:
We tested the simulator in more than 260 residents. An algorithm combining time and accuracy was used to grade performance. Voluntary postperformance surveys were used to evaluate the experience.
RESULTS:
Results demonstrate that more experienced residents have statistically significant better scores and completed the procedure in less time than inexperienced residents. Survey results revealed that most residents agreed that practice on the simulator would help with future ventriculostomies.
CONCLUSION:
This mixed reality simulator provides a real-life experience, and will be an instrumental tool in training the next generation of neurosurgeons. We have now implemented a standard where incoming residents must prove efficiency and skill on the simulator before their first interaction with a patient.
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Affiliation(s)
| | - J. Richard Lister
- Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Gwen Lombard
- Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - David E. Lizdas
- Department of Anesthesiology, Center for Safety, Simulation & Advanced Learning Technologies, University of Florida, Gainesville, Florida
| | - Samsun Lampotang
- Department of Anesthesiology, Center for Safety, Simulation & Advanced Learning Technologies, University of Florida, Gainesville, Florida
| | - Didier A. Rajon
- Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Frank Bova
- Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Gregory J.A. Murad
- Department of Neurological Surgery, University of Florida, Gainesville, Florida
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Rosseau G, Bailes J, del Maestro R, Cabral A, Choudhury N, Comas O, Debergue P, De Luca G, Hovdebo J, Jiang D, Laroche D, Neubauer A, Pazos V, Thibault F, Diraddo R. The development of a virtual simulator for training neurosurgeons to perform and perfect endoscopic endonasal transsphenoidal surgery. Neurosurgery 2014; 73 Suppl 1:85-93. [PMID: 24051889 DOI: 10.1227/neu.0000000000000112] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND A virtual reality (VR) neurosurgical simulator with haptic feedback may provide the best model for training and perfecting surgical techniques for transsphenoidal approaches to the sella turcica and cranial base. Currently there are 2 commercially available simulators: NeuroTouch (Cranio and Endo) developed by the National Research Council of Canada in collaboration with surgeons at teaching hospitals in Canada, and the Immersive Touch. Work in progress on other simulators at additional institutions is currently unpublished. OBJECTIVE This article describes a newly developed application of the NeuroTouch simulator that facilitates the performance and assessment of technical skills for endoscopic endonasal transsphenoidal surgical procedures as well as plans for collecting metrics during its early use. METHODS The main components of the NeuroTouch-Endo VR neurosurgical simulator are a stereovision system, bimanual haptic tool manipulators, and high-end computers. The software engine continues to evolve, allowing additional surgical tasks to be performed in the VR environment. Device utility for efficient practice and performance metrics continue to be developed by its originators in collaboration with neurosurgeons at several teaching hospitals in the United States. Training tasks are being developed for teaching 1- and 2-nostril endonasal transsphenoidal approaches. Practice sessions benefit from anatomic labeling of normal structures along the surgical approach and inclusion (for avoidance) of critical structures, such as the internal carotid arteries and optic nerves. CONCLUSION The simulation software for NeuroTouch-Endo VR simulation of transsphenoidal surgery provides an opportunity for beta testing, validation, and evaluation of performance metrics for use in neurosurgical residency training. ABBREVIATIONS CTA, cognitive task analysisVR, virtual reality.
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Affiliation(s)
- Gail Rosseau
- *Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois; ‡Neurosurgical Simulation Research Centre, Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada; §National Research Council Canada, Boucherville, Quebec, Canada; ¶National Research Council Canada, Winnipeg, Manitoba, Canada
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25
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Higurashi M, Qian Y, Zecca M, Park YK, Umezu M, Morgan MK. Surgical training technology for cerebrovascular anastomosis. J Clin Neurosci 2014; 21:554-8. [DOI: 10.1016/j.jocn.2013.07.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
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d'Avella E, Angileri F, de Notaris M, Enseñat J, Stagno V, Cavallo LM, Gonzales JB, Weiss A, Prats-Galino A. Extended endoscopic endonasal transclival approach to the ventrolateral brainstem and related cisternal spaces: anatomical study. Neurosurg Rev 2014; 37:253-60; discussion 260. [PMID: 24497268 DOI: 10.1007/s10143-014-0526-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 10/02/2013] [Accepted: 10/27/2013] [Indexed: 10/25/2022]
Abstract
Advances in endoscopic endonasal skull base surgery have led to the development of new routes to areas beyond the midline skull base. Recently, feasible surgical corridors to the lateral skull base have been described. The aim of this study was to describe the anatomical exposure of the ventrolateral brainstem and posterior fossa through an extended endoscopic endonasal transclival transpetrosal and transcondylar approach. Six human heads were used for the dissection process. The arterial and venous systems were injected with red- and blue-colored latex, respectively. A pre- and postoperative computed tomography (CT) scan was carried out on every head. The endoscopic endonasal transclival approach was extended through an anterior petrosectomy and a medial condylectomy. A three-dimensional model of the approach was reconstructed, using a dedicated software, from the overlapping of the pre- and post-dissection CT imaging of the specimen. An extended endoscopic transclival approach allows to gain access through an extradural anterior petrosectomy and medial condylectomy to the anterolateral surface of the brainstem and the posterior fossa. Two main intradural anatomical corridors can be described: first, between the V cranial nerve in the prepontine cistern and the VII-VIII cranial nerves in the cerebellopontine and cerebellomedullary cistern; second, between the VII-VIII cranial nerves and the IX cranial nerve, in the premedullary cistern. Extending the transclival endoscopic approach by performing an extradural anterior petrosectomy and a medial condylectomy provides a safe and wide exposure of the anterolateral brainstem with feasible surgical corridors around the main neurovascular structures.
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Affiliation(s)
- Elena d'Avella
- Department of Neurological Science, Division of Neurosurgery, University of Padua, Via Giustinianeo 2, 00135, Padua, Italy,
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27
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Chen J. Three-dimensional virtual reality simulation of periarticular tumors using Dextroscope reconstruction and simulated surgery: A preliminary 10-case study. Med Sci Monit 2014; 20:1043-50. [PMID: 24961404 DOI: 10.12659/msm.889770] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jie Chen
- Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China (mainland)
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28
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Sikder S, Tuwairqi K, Al-Kahtani E, Myers WG, Banerjee P. Surgical simulators in cataract surgery training. Br J Ophthalmol 2013; 98:154-8. [PMID: 24158838 DOI: 10.1136/bjophthalmol-2013-303700] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Virtual simulators have been widely implemented in medical and surgical training, including ophthalmology. The increasing number of published articles in this field mandates a review of the available results to assess current technology and explore future opportunities. METHOD A PubMed search was conducted and a total of 10 articles were reviewed. RESULTS Virtual simulators have shown construct validity in many modules, successfully differentiating user experience levels during simulated phacoemulsification surgery. Simulators have also shown improvements in wet-lab performance. The implementation of simulators in the residency training has been associated with a decrease in cataract surgery complication rates. CONCLUSIONS Virtual reality simulators are an effective tool in measuring performance and differentiating trainee skill level. Additionally, they may be useful in improving surgical skill and patient outcomes in cataract surgery. Future opportunities rely on taking advantage of technical improvements in simulators for education and research.
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Affiliation(s)
- Shameema Sikder
- Wilmer Eye Institute, Johns Hopkins University, , Baltimore, Maryland, USA
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29
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Rosseau G, Bailes J, del Maestro R, Cabral A, Choudhury N, Comas O, Debergue P, De Luca G, Hovdebo J, Jiang D, Laroche D, Neubauer A, Pazos V, Thibault F, DiRaddo R. The Development of a Virtual Simulator for Training Neurosurgeons to Perform and Perfect Endoscopic Endonasal Transsphenoidal Surgery. Neurosurgery 2013. [DOI: 10.1093/neurosurgery/73.suppl_1.s85] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
BACKGROUND:
A virtual reality (VR) neurosurgical simulator with haptic feedback may provide the best model for training and perfecting surgical techniques for transsphenoidal approaches to the sella turcica and cranial base. Currently there are 2 commercially available simulators: NeuroTouch (Cranio and Endo) developed by the National Research Council of Canada in collaboration with surgeons at teaching hospitals in Canada, and the Immersive Touch. Work in progress on other simulators at additional institutions is currently unpublished.
OBJECTIVE:
This article describes a newly developed application of the NeuroTouch simulator that facilitates the performance and assessment of technical skills for endoscopic endonasal transsphenoidal surgical procedures as well as plans for collecting metrics during its early use.
METHODS:
The main components of the NeuroTouch-Endo VR neurosurgical simulator are a stereovision system, bimanual haptic tool manipulators, and high-end computers. The software engine continues to evolve, allowing additional surgical tasks to be performed in the VR environment. Device utility for efficient practice and performance metrics continue to be developed by its originators in collaboration with neurosurgeons at several teaching hospitals in the United States. Training tasks are being developed for teaching 1- and 2-nostril endonasal transsphenoidal approaches. Practice sessions benefit from anatomic labeling of normal structures along the surgical approach and inclusion (for avoidance) of critical structures, such as the internal carotid arteries and optic nerves.
CONCLUSION:
The simulation software for NeuroTouch-Endo VR simulation of transsphenoidal surgery provides an opportunity for beta testing, validation, and evaluation of performance metrics for use in neurosurgical residency training.
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Affiliation(s)
- Gail Rosseau
- Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois
| | - Julian Bailes
- Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois
| | - Rolando del Maestro
- Neurosurgical Simulation Research Centre, Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada
| | - Anne Cabral
- National Research Council Canada, Boucherville, Quebec, Canada
| | | | - Olivier Comas
- National Research Council Canada, Boucherville, Quebec, Canada
| | | | - Gino De Luca
- National Research Council Canada, Boucherville, Quebec, Canada
| | - Jordan Hovdebo
- National Research Council Canada, Winnipeg, Manitoba, Canada
| | - Di Jiang
- National Research Council Canada, Boucherville, Quebec, Canada
| | - Denis Laroche
- National Research Council Canada, Boucherville, Quebec, Canada
| | - Andre Neubauer
- National Research Council Canada, Boucherville, Quebec, Canada
| | - Valerie Pazos
- National Research Council Canada, Boucherville, Quebec, Canada
| | | | - Robert DiRaddo
- National Research Council Canada, Boucherville, Quebec, Canada
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Shimizu M, Imai H, Kagoshima K, Umezawa E, Shimizu T, Yoshimoto Y. Detection of Compression Vessels in Trigeminal Neuralgia by Surface-Rendering Three-Dimensional Reconstruction of 1.5- and 3.0-T Magnetic Resonance Imaging. World Neurosurg 2013; 80:378-85. [DOI: 10.1016/j.wneu.2012.05.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 05/18/2012] [Accepted: 05/22/2012] [Indexed: 11/15/2022]
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Yoshino M, Kin T, Saito T, Nakagawa D, Nakatomi H, Kunimatsu A, Oyama H, Saito N. Optimal setting of image bounding box can improve registration accuracy of diffusion tensor tractography. Int J Comput Assist Radiol Surg 2013; 9:333-339. [PMID: 23959670 DOI: 10.1007/s11548-013-0934-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 07/30/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE When we register diffusion tensor tractography (DTT) to anatomical images such as fast imaging employing steady-state acquisition (FIESTA), we register the B0 image to FIESTA. Precise registration of the DTT B0 image to FIESTA is possible with non-rigid registration compared to rigid registration, although the non-rigid methods lack convenience. We report the effect of image data bounding box settings on registration accuracy using a normalized mutual information (NMI) method METHODS: MRI scans of 10 patients were used in this study. Registration was performed without modification of the bounding box in the control group, and the results were compared with groups re-registered using multiple bounding boxes limited to the region of interest (ROI). The distance of misalignment after registration at 3 anatomical characteristic points that are common to both FIESTA and B0 images was used as an index of accuracy. RESULTS Mean ([Formula: see text]SD) misalignment at the 3 anatomical points decreased significantly from [Formula: see text] to [Formula: see text] mm, [Formula: see text]), [Formula: see text] to [Formula: see text] mm, ([Formula: see text], and [Formula: see text] to [Formula: see text] mm, ([Formula: see text], each showing improvement compared to the control group CONCLUSION: Narrowing the image data bounding box to the ROI improves the accuracy of registering B0 images to FIESTA by NMI method. With our proposed methodology, accuracy can be improved in extremely easy steps, and this methodology may prove useful for DTT registration to anatomical image.
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Affiliation(s)
- Masanori Yoshino
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan,
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Presurgical planning of feeder resection with realistic three-dimensional virtual operation field in patient with cerebellopontine angle meningioma. Acta Neurochir (Wien) 2013; 155:1391-9. [PMID: 23722311 DOI: 10.1007/s00701-013-1761-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND To devascularize meningiomas, the precise location of tumor attachment must be known. However, when a cerebellopontine angle (CPA) meningioma is in contact with many surrounding structures, it can be difficult to distinguish the most vascularized attachment (MVA) from other contact surfaces. OBJECTIVE To validate the usefulness of a virtual operation field (VOF) of a CPA meningioma by high-spatial-resolution three-dimensional computer graphics (hs-3DCG). METHODS Presurgical simulation with VOF was performed for eight CPA meningiomas to assess the MVA and the appropriate route to the main feeder. For hs-3DCG, the necessary preoperative radiographic images were fused. A hybrid model of volume and surface rendering was created from the fused images. The simulation results were compared with the operative results, and the MVA estimation rate was compared between VOF and contrast-enhanced fast imaging employing steady-state acquisition. RESULTS By using VOF, the point at which the main feeder penetrated the tumor was estimated in all cases, and using this information, the MVA was detected. All patients underwent resection of the main feeder in the same way as simulated preoperatively. Estimation rates of MVA were 37.5% in CE-FIESTA and 100% in VOF (p = 0.02, Fisher's exact test). CONCLUSION The hs-3DCG method was of sufficiently high quality to enable VOF of CPA meningioma. This method may facilitate estimation of MVA and the main feeder penetration point, and may aid in the determination of the most appropriate approach to the main feeder.
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Oishi M, Fukuda M, Yajima N, Yoshida K, Takahashi M, Hiraishi T, Takao T, Saito A, Fujii Y. Interactive presurgical simulation applying advanced 3D imaging and modeling techniques for skull base and deep tumors. J Neurosurg 2013; 119:94-105. [DOI: 10.3171/2013.3.jns121109] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
In this paper, the authors' goal was to report their novel presurgical simulation method applying interactive virtual simulation (IVS) using 3D computer graphics (CG) data and microscopic observation of color-printed plaster models based on these CG data in surgery for skull base and deep tumors.
Methods
For 25 operations in 23 patients with skull base or deep intracranial tumors (meningiomas, schwannomas, epidermoid tumors, chordomas, and others), the authors carried out presurgical simulation based on 3D CG data created by image analysis for radiological data. Interactive virtual simulation was performed by modifying the 3D CG data to imitate various surgical procedures, such as bone drilling, brain retraction, and tumor removal, with manipulation of a haptic device. The authors also produced color-printed plaster models of modified 3D CG data by a selective laser sintering method and observed them under the operative microscope.
Results
In all patients, IVS provided detailed and realistic surgical perspectives of sufficient quality, thereby allowing surgeons to determine an appropriate and feasible surgical approach. Surgeons agreed that in 44% of the 25 operations IVS showed high utility (as indicated by a rating of “prominent”) in comprehending 3D microsurgical anatomies for which reconstruction using only 2D images was complicated. Microscopic observation of color-printed plaster models in 12 patients provided further utility in confirming realistic surgical anatomies.
Conclusions
The authors' presurgical simulation method applying advanced 3D imaging and modeling techniques provided a realistic environment for practicing microsurgical procedures virtually and enabled the authors to ascertain complex microsurgical anatomy, to determine the optimal surgical strategies, and also to efficiently educate neurosurgical trainees, especially during surgery for skull base and deep tumors.
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Affiliation(s)
- Makoto Oishi
- 1Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata; and
| | - Masafumi Fukuda
- 1Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata; and
| | - Naoki Yajima
- 1Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata; and
| | - Kenzo Yoshida
- 23D Solution, Toyotsu Machinery Corporation, Tokyo, Japan
| | | | - Tetsuya Hiraishi
- 1Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata; and
| | - Tetsuro Takao
- 1Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata; and
| | - Akihiko Saito
- 1Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata; and
| | - Yukihiko Fujii
- 1Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata; and
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Haji FA, Dubrowski A, Drake J, de Ribaupierre S. Needs assessment for simulation training in neuroendoscopy: a Canadian national survey. J Neurosurg 2013; 118:250-7. [DOI: 10.3171/2012.10.jns12767] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Object
In recent years, dramatic changes in surgical education have increased interest in simulation-based training for complex surgical skills. This is particularly true for endoscopic third ventriculostomy (ETV), given the potential for serious intraoperative errors arising from surgical inexperience. However, prior to simulator development, a thorough assessment of training needs is essential to ensure development of educationally relevant platforms. The purpose of this study was to conduct a national needs assessment addressing specific goals of instruction, to guide development of simulation platforms, training curricula, and assessment metrics for ETV.
Methods
Canadian neurosurgeons performing ETV were invited to participate in a structured online questionnaire regarding the procedural steps for ETV, the frequency and significance of intraoperative errors committed while learning the technique, and simulation training modules of greatest potential educational benefit. Descriptive data analysis was completed for both quantitative and qualitative responses.
Results
Thirty-two (55.2%) of 58 surgeons completed the survey. All believed that virtual reality simulation training for ETV would be a valuable addition to clinical training. Selection of ventriculostomy site, navigation within the ventricles, and performance of the ventriculostomy ranked as the most important steps to simulate. Technically inadequate ventriculostomy and inappropriate fenestration site selection were ranked as the most frequent/significant errors. A standard ETV module was thought to be most beneficial for resident training.
Conclusions
To inform the development of a simulation-based training program for ETV, the authors have conducted a national needs assessment. The results provide valuable insight to inform key design elements necessary to construct an educationally relevant device and educational program.
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Affiliation(s)
- Faizal A. Haji
- 1Schulich School of Medicine and Dentistry, University of Western Ontario, London
- 2Clinical Neurological Sciences, London Health Sciences Centre, London
- 3The Wilson Centre, Faculty of Medicine, University of Toronto
- 4SickKids Learning Institute, and
| | - Adam Dubrowski
- 3The Wilson Centre, Faculty of Medicine, University of Toronto
- 4SickKids Learning Institute, and
| | - James Drake
- 5Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sandrine de Ribaupierre
- 1Schulich School of Medicine and Dentistry, University of Western Ontario, London
- 2Clinical Neurological Sciences, London Health Sciences Centre, London
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Kockro RA, Reisch R, Serra L, Goh LC, Lee E, Stadie AT. Image-Guided Neurosurgery With 3-Dimensional Multimodal Imaging Data on a Stereoscopic Monitor. Neurosurgery 2013; 72 Suppl 1:78-88. [DOI: 10.1227/neu.0b013e3182739aae] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Chan S, Conti F, Salisbury K, Blevins NH. Virtual Reality Simulation in Neurosurgery. Neurosurgery 2013; 72 Suppl 1:154-64. [DOI: 10.1227/neu.0b013e3182750d26] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Apuzzo MLJ, Pagán VM, Faccio R, Liu CY. A Bosphorus submarine passage and the reinvention of neurosurgery. World Neurosurg 2012. [PMID: 23177761 DOI: 10.1016/j.wneu.2012.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
One of the major themes characterizing the emergence of modern neurosurgery has been the concept of technology transfer and the application of a broad spectrum of revolutionary elements of technology from both physical and biological science. These transference applications are now apparent in modern neurosurgery as it is practiced on all continents of the globe. More than 3 decades ago, these ideas that now have come to fruition were in states of formulation. This article describes and further documents one such fertile cauldron of ideas and practical realities--the United States Navy Nuclear Submarine Service and its role and affect on the life and professional career of an academic neurosurgeon who was active in areas of progress as modernity was established for the early 21st century.
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Affiliation(s)
- Michael L J Apuzzo
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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From Planes to Brains: Parallels Between Military Development of Virtual Reality Environments and Virtual Neurological Surgery. World Neurosurg 2012; 78:214-9. [DOI: 10.1016/j.wneu.2012.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 03/29/2012] [Accepted: 06/13/2012] [Indexed: 11/21/2022]
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Agrawal A, Kato Y, Sano H, Kanno T. The incorporation of neuroendoscopy in neurosurgical training programs. World Neurosurg 2012; 79:S15.e11-3. [PMID: 22381835 DOI: 10.1016/j.wneu.2012.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 02/03/2012] [Indexed: 10/14/2022]
Abstract
Previously considered the domain of the otolaryngologists, the endoscopy is now a common part of the armamentarium of a neurosurgeon. Neuroendoscopy or endoscope-assisted microsurgery is now being used in almost all routine procedures performed in the neurosurgical operating room. Hands-on training has become essential to learn the basics of neuroendoscopy, even for neurosurgeons well accustomed to the use of microscopes. To decrease the slope of the learning curve of residents during their training and reduce complications of procedures, most neurosurgery training programs around the world have incorporated laboratory or dissection programs in their curricula. Preconference workshops held during annual meetings are also an excellent tool to aid in the transition of surgeons from being a resident under the umbrella of an attending neurosurgeon to being a neurosurgeon able to operate independently and with confidence. In this "tech-savvy era," various cadaver or synthetic models are readily available for endoscopy training in a virtually simulated environment. In accord with the results of a surveys conducted by individual groups and societies, the authors firmly believe that incorporation of endoscopy in the neurosurgical curriculum would add a new dimension to the existing protocol. There is an urgent need for dedicated endoscopy training programs similar to postresidency fellowships in addition to translational research and establishment of dedicated societies to formulate guidelines for such research and monitor its progress.
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Affiliation(s)
- Abhishek Agrawal
- Department of Neurosurgery, Fujita Health University Hospital, Nagoya, Japan
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Robison RA, Liu CY, Apuzzo ML. Man, Mind, and Machine: The Past and Future of Virtual Reality Simulation in Neurologic Surgery. World Neurosurg 2011; 76:419-30. [DOI: 10.1016/j.wneu.2011.07.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 07/07/2011] [Indexed: 10/14/2022]
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Wang SS, Xue L, Jing JJ, Wang RM. Virtual reality surgical anatomy of the sphenoid sinus and adjacent structures by the transnasal approach. J Craniomaxillofac Surg 2011; 40:494-9. [PMID: 21996723 DOI: 10.1016/j.jcms.2011.08.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 08/24/2011] [Accepted: 08/24/2011] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the three-dimensional virtual anatomical features of the sphenoid sinus and adjacent structures during virtual surgery and explore their relevance to actual transsphenoidal surgery. METHODS CT images of the sphenoid sinus and surrounding structures from 28 Chinese adult patients were measured using a 16-slice helical CT scanner. Image analysis was performed using the volume-rendering method. Two experienced neurosurgeons wearing stereoscopic glasses performed virtual transsphenoidal surgery by the transnasal approach. RESULTS The virtual anatomical features of the sphenoid sinus and the adjacent structures during virtual surgery were described. The distance from the sphenopalatine foramen to the left and right sphenoid ostium was 10.1 ± 2.7 mm and 10.5 ± 3.2 mm, respectively, to the left and right sphenoidal crest 12.9 ± 2.0 mm and 12.8 ± 2.2 mm, respectively, and to the left and right uncinate process 24.0 ± 1.9 mm and 23.9 ± 2.0 mm, respectively. The distance from the uncinate process to the medial and lateral edge of the most prominent part of the anterior bend of the cavernous internal carotid artery (ICA) was 33.7 ± 3.7 mm and 34.8 ± 3.7 mm, respectively, and the angle between the two lines was 9.7 ± 1.9°. CONCLUSION The study provides virtual anatomical information about the sphenoid sinus and important surrounding structures that is essential for successful real life transsphenoidal surgery.
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Affiliation(s)
- Shou-Sen Wang
- Department of Neurosurgery, Fuzhou General Hospital, 156 Xihuanbei Road, Fuzhou 350025, China.
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Oishi M, Fukuda M, Ishida G, Saito A, Hiraishi T, Fujii Y. Prediction of the microsurgical window for skull-base tumors by advanced three-dimensional multi-fusion volumetric imaging. Neurol Med Chir (Tokyo) 2011; 51:201-7. [PMID: 21441736 DOI: 10.2176/nmc.51.201] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The surgery of skull base tumors (SBTs) is difficult due to the complex and narrow surgical window that is restricted by the cranium and important structures. The utility of three-dimensional multi-fusion volumetric imaging (3-D MFVI) for visualizing the predicted window for SBTs was evaluated. Presurgical simulation using 3-D MFVI was performed in 32 patients with SBTs. Imaging data were collected from computed tomography, magnetic resonance imaging, and digital subtraction angiography. Skull data was processed to imitate actual bone resection and integrated with various structures extracted from appropriate imaging modalities by image-analyzing software. The simulated views were compared with the views obtained during surgery. All craniotomies and bone resections except opening of the acoustic canal in 2 patients were performed as simulated. The simulated window allowed observation of the expected microsurgical anatomies including tumors, vasculatures, and cranial nerves, through the predicted operative window. We could not achieve the planned tumor removal in only 3 patients. 3-D MFVI afforded high quality images of the relevant microsurgical anatomies during the surgery of SBTs. The intraoperative déjà-vu effect of the simulation increased the confidence of the surgeon in the planned surgical procedures.
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Affiliation(s)
- Makoto Oishi
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
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The use of a three-dimensional novel computer-based model for analysis of the endonasal endoscopic approach to the midline skull base. World Neurosurg 2011; 75:106-13; discussion 36-40. [PMID: 21492673 DOI: 10.1016/j.wneu.2010.09.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 09/18/2010] [Accepted: 09/27/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To apply a three-dimensional geometric model to various endoscopic endonasal approaches to analyze the bony anatomy of this area, quantify preoperatively bone removal, and optimize surgical planning. METHODS Investigators dissected 18 human cadaveric heads at the Laboratory of Surgical NeuroAnatomy (LSNA) of the University of Barcelona (Spain). Before and after each dissection, a computed tomography (CT) scan was performed to create a three-dimensional geometric model of the approach performed in the dissection room. The model protocol was designed as follows: (i) a preliminary exploration of each specimen using the preoperative CT scan, (ii) creation of a computer-generated three-dimensional virtual model of the approach, (iii) cadaveric anatomic dissection, and (iv) development of a CT-based model of the approach as a result of the superimposition of predissection and postdissection digital imaging and communications in medicine (DICOM) images of specimens. RESULTS This method employing preliminary virtual exploration of each specimen, the creation of a three-dimensional virtual model of the approach, and the overlapping of the predissection and postdissection three-dimensional models was useful to define the exact boundaries of the endoscopic endonasal craniectomy. CONCLUSIONS Aside from laboratory anatomic dissection itself, this model is very effective in providing a depiction of bony landmarks and visual feedback of the amount of bone removed, improving the design of the craniectomy in the endoscopic endonasal midline skull base approach.
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Oishi M, Fukuda M, Ishida G, Saito A, Hiraishi T, Fujii Y. Presurgical simulation with advanced 3-dimensional multifusion volumetric imaging in patients with skull base tumors. Neurosurgery 2011; 68:188-99; discussion 199. [PMID: 21304332 DOI: 10.1227/neu.0b013e318207b3ad] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite recent diagnostic and technical advancements in the field of neurosurgery, surgical treatment for tumors in the skull base region, ie, skull base tumors (SBTs), remains a challenge. OBJECTIVE To validate the utility of presurgical simulation for the treatment of SBTs by 3-dimensional multifusion volumetric imaging (3D MFVI), including volume rendering and image fusion, to combine data from various imaging modalities. METHODS We performed presurgical simulation using 3D MFVI for 21 SBTs (acoustic neurinomas, jugular neurinomas, meningiomas, chordomas, and others) in 20 patients. We collected targeted data from computed tomography, magnetic resonance imaging, computed tomography or magnetic resonance angiography, and digital subtraction angiography and combined these data using image-analyzing software. The simulations were used to assess the 3D relationships among the microsurgical anatomical components, the appropriate surgical approach, and the resectable parts of the tumor. Finally, we compared the results of the simulation with the operative results. RESULTS In all patients, the 3D MFVI techniques enabled adequate visualization of the microsurgical anatomy and facilitated presurgical simulation, thereby allowing the surgeons to determine an appropriate and feasible surgical approach. All procedures to open the bone window were performed in accordance with the simulations, except for the surgical exposure of the acoustic canal for 2 acoustic neurinomas. In 3 of the 21 cases, tumor removal could not be performed according to the simulations because of unexpected bleeding or other restrictions. CONCLUSION The 3D MFVI technique was of a sufficiently high quality to enable visualization of the 3D microsurgical anatomy. This promising method can facilitate determination of the most appropriate approach and safe and precise surgical procedures for SBTs.
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Affiliation(s)
- Makoto Oishi
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
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Suebnukarn S, Hataidechadusadee R, Suwannasri N, Suprasert N, Rhienmora P, Haddawy P. Access cavity preparation training using haptic virtual reality and microcomputed tomography tooth models. Int Endod J 2011; 44:983-9. [PMID: 21623838 DOI: 10.1111/j.1365-2591.2011.01899.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Suebnukarn
- Faculty of Dentistry, Thammasat University, Pathumthani, Thailand.
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Alaraj A, Lemole MG, Finkle JH, Yudkowsky R, Wallace A, Luciano C, Banerjee PP, Rizzi SH, Charbel FT. Virtual reality training in neurosurgery: Review of current status and future applications. Surg Neurol Int 2011; 2:52. [PMID: 21697968 PMCID: PMC3114314 DOI: 10.4103/2152-7806.80117] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Accepted: 03/18/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Over years, surgical training is changing and years of tradition are being challenged by legal and ethical concerns for patient safety, work hour restrictions, and the cost of operating room time. Surgical simulation and skill training offer an opportunity to teach and practice advanced techniques before attempting them on patients. Simulation training can be as straightforward as using real instruments and video equipment to manipulate simulated "tissue" in a box trainer. More advanced virtual reality (VR) simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations. METHODS A PubMed review of the literature was performed for the MESH words "Virtual reality, "Augmented Reality", "Simulation", "Training", and "Neurosurgery". Relevant articles were retrieved and reviewed. A review of the literature was performed for the history, current status of VR simulation in neurosurgery. RESULTS Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and credential surgeons as technically competent. The number of published literature discussing the application of VR simulation in neurosurgery training has evolved over the last decade from data visualization, including stereoscopic evaluation to more complex augmented reality models. With the revolution of computational analysis abilities, fully immersive VR models are currently available in neurosurgery training. Ventriculostomy catheters insertion, endoscopic and endovascular simulations are used in neurosurgical residency training centers across the world. Recent studies have shown the coloration of proficiency with those simulators and levels of experience in the real world. CONCLUSION Fully immersive technology is starting to be applied to the practice of neurosurgery. In the near future, detailed VR neurosurgical modules will evolve to be an essential part of the curriculum of the training of neurosurgeons.
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Affiliation(s)
- Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago College of Medicine, Chicago, USA
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Le TD, Adatia FA, Lam WC. Virtual reality ophthalmic surgical simulation as a feasible training and assessment tool: results of a multicentre study. Can J Ophthalmol 2011; 46:56-60. [DOI: 10.3129/i10-051] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Malone HR, Syed ON, Downes MS, D'Ambrosio AL, Quest DO, Kaiser MG. Simulation in neurosurgery: a review of computer-based simulation environments and their surgical applications. Neurosurgery 2011; 67:1105-16. [PMID: 20881575 DOI: 10.1227/neu.0b013e3181ee46d0] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Computer-based surgical simulators create a no-risk virtual environment where surgeons can develop and refine skills through harmless repetition. These applications may be of particular benefit to neurosurgeons, as the vulnerability of nervous tissue limits the margin for error. The rapid progression of computer-processing capabilities in recent years has led to the development of more sophisticated and realistic neurosurgery simulators. OBJECTIVE To catalogue the most salient of these advances and characterize our current effort to create a spine surgery simulator. METHODS An extensive search of the databases Ovid-MEDLINE, PubMed, and Google Scholar was conducted. Search terms included, but were not limited to: neurosurgery combined with simulation, virtual reality, haptics, and 3-dimensional imaging. RESULTS A survey of the literature reveals that surgical simulators are evolving from platforms used for preoperative planning and anatomic education into programs that aim to simulate essential components of key neurosurgical procedures. This evolution is predicated upon the advancement of 3 main components of simulation: graphics/volume rendering, model behavior/tissue deformation, and haptic feedback. CONCLUSION The computational burden created by the integration of these complex components often limits the fluidity of real-time interactive simulators. Although haptic interfaces have become increasingly sophisticated, the production of realistic tactile sensory feedback remains a formidable and costly challenge. The rate of future progress may be contingent upon international collaboration between research groups and the establishment of common simulation platforms. Given current limitations, the most potential for growth lies in the innovative design of models that expand the procedural applications of neurosurgery simulation environments.
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Affiliation(s)
- Hani R Malone
- Department of Neurosurgery, Columbia University Medical Center, New York, New York, USA
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Kuroda Y, Kamada K, Hayashi Y, Imura M, Oshiro O. Multimodal Neurosurgery Force Feedback System Based on Mesh Fusion Modeling. Biocybern Biomed Eng 2011. [DOI: 10.1016/s0208-5216(11)70009-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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