Apr 25, 2017 | By Tess

In the medical field, if practice doesn’t make perfect, it’s bound to at least get you close. But training doctors (and especially surgeons) can be somewhat tricky, as it requires using real human bodies or lifelike simulation models, which up until now have been difficult to produce. In recent years, 3D printing has been used to create increasingly realistic-looking surgical models, but those working in the field have struggled to capture the feel, texture, and movements of the human anatomy in a 3D printed model.

Low fidelity simulated surgical training model for ETV (left), high fidelity model (right)

Now, however, thanks to an innovative collaboration between neurosurgeons, neuroradiologists, simulation engineers, and special effects experts, this feat doesn’t seem so impossible. Together, the interdisciplinary team have developed a 3D printed training tool that is designed to help neurosurgical trainees perform a minimally invasive surgical procedure.

Research on the simulation model, which combines medical expertise with Hollywood-style special effects, was recently published in the Journal of Neurosurgery: Pediatrics under the title “Creation of a novel simulator for minimally invasive neurosurgery: fusion of 3D printing and special effects.” It was authored by Peter Weinstock, MD, PhD and colleagues from the Boston Children’s Hospital.

The 3D printed training simulation model developed by the team is a full-scale replica of the head of an adolescent who has hydrocephalus, a condition that causes increased pressure inside the skull because of excess cerebrospinal fluid. The 3D printed model is incredibly realistic, as it reproduces both the external appearance of the head and its internal neuroanatomy.

Original MRI study and imaging segmentation for the 3D printed hydrocephalus model

Unlike many existing 3D printed simulation models, which often cannot properly mimic the feel and texture of human tissues, the neurosurgical model integrates realistic special effects materials that come close to the feel and appearance of organic skin and even brain structures. After all, who better to recreate human-like materials than some of Hollywood’s top special effects people who can convince us of virtually anything on the screen.

Impressively, the 3D printed model is also designed to come “alive” during the operation, so to speak, as its various components pulse and move just like a real human brain would. Having these realistic features (such as a simulated basilar artery and ventricles, and cerebrospinal fluid movements) provides the surgeons in training with both visual and tactile feedback that makes the experience feel all the more real.

Typically, a neurosurgeon in training will undergo a rigorous residency that generally lasts about seven years. This means that for several years they are not even allowed to touch a patient, and must simply learn by observing more experienced neurosurgeons and practice their surgical skills using the other means at their disposal. Up until now, training processes have largely relied on using human cadavers, which are expensive to store and to procure, or virtual reality programs, which are not as realistic as working on a physical model. The idea behind the 3D printed animated surgical model is to offer a more realistic and more affordable training tool for neurosurgeons.

ETV trainer assembly

As the research paper explains, the 3D printed training model was tested using a third ventriculostomy procedure (ETV), a minimally invasive surgical operation that is commonly used to treat hydrocephalus. While we won’t go into much detail about the procedure, it essentially consists of making a hole in the floor of the third ventricle to enable circulation for excess cerebrospinal fluid. During ETV, an endoscope fitted with a mini video camera is typically inserted through the skull into the ventricular system to help visualize the procedure and provide real-time feedback to the surgeons.

In testing the 3D printed surgical model, the research team invited various neurosurgeon residents and fellows along with their teachers to perform the procedure and to answer detailed questionnaires about the model’s appearances and tactile feel. In the end, the neurosurgical residents and fellows gave the 3D printed training model high scores for its face and content validity: 4.69 and 4.88 (out of 5) respectively.

Alan R. Cohen, MD, at Johns Hopkins Hospital, the senior author of the paper, said, "This unique collaboration of interdisciplinary experts resulted in the creation of an ultra-realistic 3D surgical training model. Simulation has become increasingly important for training in minimally invasive neurosurgery. It also has the potential to revolutionize training for all surgical procedures.”

ETV performed with simulator using a 0° endoscope lens 

Though the realistic 3D printed surgical model was used for hydrocephalus treatment, the researchers behind the tool have said that it can also be used for other procedures, as it incorporates a number of different plug-and-play parts that can be used for various scenarios. This modular feature also helps to reduce training costs, according to the team.

 

 

Posted in 3D Printing Application

 

 

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