Low-cost endoscopic third ventriculostomy simulator with mimetic endoscope
Low-cost endoscopic third ventriculostomy simulator with mimetic endoscope
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DOI：
10.3171/2018.2.peds17671
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发表时间：
2018-08-01
影响因子：
1.9
通讯作者：
Harris, Carolyn Anne
中科院分区：
文献类型：
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作者：
Garling, Richard Justin;Jin, Xin;Harris, Carolyn Anne
在美国，脑积水影响大约1/500的人，然而脑室分流术，治疗的金标准，有近85%的失败率。内窥镜第三脑室造口术（ETV）是一种针对特定脑积水患者子集的替代手术方法，但可能受到神经外科住院医师在接触患者之前无法实践的限制。本研究的目标是建立一个负担得起的ETV模型和内窥镜住院training.METHODS开源软件被用来隔离头骨和大脑的CT和MR图像的一个2岁的男孩脑积水。3D打印机创建了头骨和大脑的3D模型。在随后的压缩和剪切模量测试之前，使用硅酮和硅酮触觉增变剂的混合物来浇铸脑模具。然后，用基本用品和3D打印框架创建了一个模拟内窥镜。一小群神经外科住院医师和主治医师评估ETV模拟器与模拟endoscopic.Results作者成功地创建了一个模拟内窥镜和ETV模拟器。压缩和剪切模量测试后，硅胶/Slacker比例在10：6和10：7之间，被发现与人脑实质相似。87%的参与者强烈同意模拟器对住院医师培训有用，93%的参与者强烈同意模拟器帮助他们了解如何使用内窥镜定位自己。结论作者创建了一个负担得起的（123美元，不包括3D打印机），易于使用的ETV模拟器内窥镜以前的模型需要昂贵的软件和昂贵的手术内窥镜，可能无法提供给大多数居民。相反，这种尝试利用开源软件来操纵和制造患者特定的模具。该模型可以帮助住院医师开发，使他们能够安全地在ETV中练习使用内窥镜。
OBJECTIVE Hydrocephalus affects approximately 1 in 500 people in the US, yet ventricular shunting, the gold standard of treatment, has a nearly 85% failure rate. Endoscopic third ventriculostomy (ETV) is an alternative surgical approach for a specific subset of hydrocephalic patients, but can be limited by the inability of neurosurgical residents to practice prior to patient contact. The goal of this study was to create an affordable ETV model and endoscope for resident training.METHODS Open-source software was used to isolate the skull and brain from the CT and MR images of a 2-year-old boy with hydrocephalus. A 3D printer created the skull and a 3D mold of the brain. A mixture of silicone and silicone tactile mutator was used to cast the brain mold prior to subsequent compression and shearing modulus testing. A mimetic endoscope was then created from basic supplies and a 3D printed frame. A small cohort of neurosurgical residents and attending physicians evaluated the ETV simulator with mimetic endoscope.RESULTS The authors successfully created a mimetic endoscope and ETV simulator. After compression and shearing modulus testing, a silicone/Slacker ratio between 10:6 and 10:7 was found to be similar to that of human brain parenchyma Eighty-seven percent of participants strongly agreed that the simulator was useful for resident training, and 93% strongly agreed that the simulator helped them understand how to orient themselves with the endoscope.CONCLUSIONS The authors created an affordable (US$123, excluding 3D printer), easy-to-use ETV simulator with endoscope Previous models have required expensive software and costly operative endoscopes that may not be available to most residents. Instead, this attempt takes advantage of open-source software for the manipulation and fabrication of a patient-specific mold. This model can assist with resident development, allowing them to safely practice use of the endoscope in ETV.