Development and evaluation of a patient-specific surgical simulator for endoscopic colloid cyst resection

OBJECTIVEEndoscopic resection of third-ventricle colloid cysts is technically challenging due to the limited dexterity and visualization provided by neuroendoscopic instruments. Extensive training and experience are required to master the learning curve. To improve the education of neurosurgical trainees in this procedure, a synthetic surgical simulator was developed and its realism, procedural content, and utility as a training instrument were evaluated.METHODSThe simulator was developed based on the neuroimaging (axial noncontrast CT and T1-weighted gadolinium-enhanced MRI) of an 8-year-old patient with a colloid cyst and hydrocephalus. Image segmentation, computer-aided design, rapid prototyping (3D printing), and silicone molding techniques were used to produce models of the skull, brain, ventricles, and colloid cyst. The cyst was filled with a viscous fluid and secured to the roof of the third ventricle. The choroid plexus and intraventricular veins were also included. Twenty-four neurosurgical trainees performed a simulated colloid cyst resection using a 30° angled endoscope, neuroendoscopic instruments, and image guidance. Using a 19-item feedback survey (5-point Likert scales), participants evaluated the simulator across 5 domains: anatomy, instrument handling, procedural content, perceived realism, and confidence and comfort level.RESULTSParticipants found the simulator’s anatomy to be highly realistic (mean 4.34 ± 0.63 [SD]) and appreciated the use of actual instruments (mean 4.38 ± 0.58). The procedural content was also rated highly (mean 4.28 ± 0.77); however, the perceived realism was rated slightly lower (mean 4.08 ± 0.63). Participants reported greater confidence in their ability to perform an endoscopic colloid cyst resection after using the simulator (mean 4.45 ± 0.68). Twenty-three participants (95.8%) indicated that they would use the simulator for additional training. Recommendations were made to develop complex case scenarios for experienced trainees (normal-sized ventricles, choroid plexus adherent to cyst wall, bleeding scenarios) and incorporate advanced instrumentation such as side-cutting aspiration devices.CONCLUSIONSA patient-specific synthetic surgical simulator for training residents and fellows in endoscopic colloid cyst resection was successfully developed. The simulator’s anatomy, instrument handling, and procedural content were found to be realistic. The simulator may serve as a valuable educational tool to learn the critical steps of endoscopic colloid cyst resection, develop a detailed understanding of intraventricular anatomy, and gain proficiency with bimanual neuroendoscopic techniques.

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Colloid Cyst of the Third Ventricle: A Comparative Ultrastructural Study of Neuraxis Cysts and Choroid Plexus Epithelium

Ultrastructural Pathology ◽

10.3109/01913129209061362 ◽

1992 ◽

Vol 16 (3) ◽

pp. 331-349 ◽

Cited By ~ 31

Author(s):

B. Lach ◽

B. W. Scheithauer

Keyword(s):

Choroid Plexus ◽

Ultrastructural Study ◽

Third Ventricle ◽

Colloid Cyst ◽

Choroid Plexus Epithelium ◽

The Third

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Solitary metastasis to the choroid plexus of the third ventricle mimicking a colloid cyst: a report of two cases

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2003.07.001 ◽

2004 ◽

Vol 11 (5) ◽

pp. 521-523 ◽

Cited By ~ 11

Author(s):

J.C.D Leach ◽

H Garrott ◽

J.A.J King ◽

A.H Kaye

Keyword(s):

Choroid Plexus ◽

Third Ventricle ◽

Colloid Cyst ◽

Solitary Metastasis ◽

The Third

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Lesions at the Foramen of Monro Causing Obstructive Hydrocephalus

10.5772/intechopen.99594 ◽

2021 ◽

Author(s):

Ashish Chugh ◽

Sarang Gotecha ◽

Prashant Punia ◽

Neelesh Kanaskar

Keyword(s):

Choroid Plexus ◽

Intraventricular Hemorrhage ◽

Anterior Part ◽

Obstructive Hydrocephalus ◽

Third Ventricle ◽

Colloid Cyst ◽

Subependymal Giant Cell Astrocytoma ◽

Foramen Of Monro ◽

The Third ◽

Giant Cell Astrocytoma

The foramen of Monro has also been referred to by the name of interventricular foramen. The structures comprising this foramen are the anterior part of the thalamus, the fornix and the choroid plexus. Vital structures surround the foramen, the damage to which can be catastrophic leading to disability either temporary or permanent. In the literature it has been shown that tumors occurring in the area of interventricular foramen are rare and usually cause hydrocephalus. The operative approach depends upon the location of the tumor which can be either in the lateral or the third ventricle. Various pathologies which can lead to foramen of Monro obstruction and obstructive hydrocephalus include colloid cyst, craniopharyngioma, subependymal giant cell astrocytoma [SEGA], Neurocysticercosis, tuberculous meningitis, pituitary macroadenoma, neurocytoma, ventriculitis, multiseptate hydrocephalus, intraventricular hemorrhage, functionally isolated ventricles, choroid plexus tumors, subependymomas and idiopathic foramen of monro stenosis. In this chapter, we will discuss the various lesions at the level of foramen of Monro causing obstructive hydrocephalus and the management and associated complications of these lesions based on their type, clinical picture and their appearance on imaging.

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Numerical Analysis of the VAD Outflow Cannula Positioning on the Blood Flow in the Patient–Specific Brain Supplying Arteries

Mechanics and Mechanical Engineering ◽

10.2478/mme-2018-0049 ◽

2020 ◽

Vol 22 (2) ◽

pp. 619-636 ◽

Cited By ~ 1

Author(s):

Zbigniew Tyfa ◽

Damian Obidowski ◽

Krzysztof Jóźwik

Keyword(s):

Blood Flow ◽

Computer Aided Design ◽

Volume Flow Rate ◽

Flow Distribution ◽

Primary Objective ◽

Patient Specific ◽

Blood Flow Distribution ◽

Reconstruction Process ◽

Outflow Cannula ◽

The Brain

AbstractThe primary objective of this research can be divided into two separate aspects. The first one was to verify whether own software can be treated as a viable source of data for the Computer Aided Design (CAD) modelling and Computational Fluid Dynamics CFD analysis. The second aspect was to analyze the influence of the Ventricle Assist Device (VAD) outflow cannula positioning on the blood flow distribution in the brain-supplying arteries. Patient-specific model was reconstructed basing on the DICOM image sets obtained with the angiographic Computed Tomography. The reconstruction process was performed in the custom-created software, whereas the outflow cannulas were added in the SolidWorks software. Volumetric meshes were generated in the Ansys Mesher module. The transient boundary conditions enabled simulating several full cardiac cycles. Performed investigations focused mainly on volume flow rate, shear stress and velocity distribution. It was proven that custom-created software enhances the processes of the anatomical objects reconstruction. Developed geometrical files are compatible with CAD and CFD software – they can be easily manipulated and modified. Concerning the numerical simulations, several cases with varied positioning of the VAD outflow cannula were analyzed. Obtained results revealed that the location of the VAD outflow cannula has a slight impact on the blood flow distribution among the brain supplying arteries.

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3D Printing & Pharmaceutical Manufacturing: Opportunities and Challenges

International Journal of Bioassays ◽

10.21746/ijbio.2016.01.006 ◽

2016 ◽

Vol 5 (01) ◽

pp. 4723 ◽

Cited By ~ 5

Author(s):

Bhusnure O. G.* ◽

Gholve V. S. ◽

Sugave B. K. ◽

Dongre R. C. ◽

Gore S. A. ◽

...

Keyword(s):

Drug Delivery ◽

Tissue Engineering ◽

3D Printing ◽

Computer Aided Design ◽

Patient Specific ◽

Computer Design ◽

3D Scaffolds ◽

Engineering Research ◽

Advantages And Disadvantages ◽

Computer Aided

Many researchers have attempted to use computer-aided design (C.A.D) and computer-aided manufacturing (CAM) to realize a scaffold that provides a three-dimensional (3D) environment for regeneration of tissues and organs. As a result, several 3D printing technologies, including stereolithography, deposition modeling, inkjet-based printing and selective laser sintering have been developed. Because these 3D printing technologies use computers for design and fabrication, and they can fabricate 3D scaffolds as designed; as a consequence, they can be standardized. Growth of target tissues and organs requires the presence of appropriate growth factors, so fabrication of 3Dscaffold systems that release these biomolecules has been explored. A drug delivery system (D.D.S) that administrates a pharmaceutical compound to achieve a therapeutic effect in cells, animals and humans is a key technology that delivers biomolecules without side effects caused by excessive doses. 3D printing technologies and D. D. Ss have been assembled successfully, so new possibilities for improved tissue regeneration have been suggested. If the interaction between cells and scaffold system with biomolecules can be understood and controlled, and if an optimal 3D tissue regenerating environment is realized, 3D printing technologies will become an important aspect of tissue engineering research in the near future. 3D Printing promises to produce complex biomedical devices according to computer design using patient-specific anatomical data. Since its initial use as pre-surgical visualization models and tooling molds, 3D Printing has slowly evolved to create one-of-a-kind devices, implants, scaffolds for tissue engineering, diagnostic platforms, and drug delivery systems. Fuelled by the recent explosion in public interest and access to affordable printers, there is renewed interest to combine stem cells with custom 3D scaffolds for personalized regenerative medicine. Before 3D Printing can be used routinely for the regeneration of complex tissues (e.g. bone, cartilage, muscles, vessels, nerves in the craniomaxillofacial complex), and complex organs with intricate 3D microarchitecture (e.g. liver, lymphoid organs), several technological limitations must be addressed. Until recently, tablet designs had been restricted to the relatively small number of shapes that are easily achievable using traditional manufacturing methods. As 3D printing capabilities develop further, safety and regulatory concerns are addressed and the cost of the technology falls, contract manufacturers and pharmaceutical companies that experiment with these 3D printing innovations are likely to gain a competitive edge. This review compose the basics, types & techniques used, advantages and disadvantages of 3D printing

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An MRI-Based Patient-Specific Computational Framework for the Calculation of Range of Motion of Total Hip Replacements

Applied Sciences ◽

10.3390/app11062852 ◽

2021 ◽

Vol 11 (6) ◽

pp. 2852

Author(s):

Maeruan Kebbach ◽

Christian Schulze ◽

Christian Meyenburg ◽

Daniel Kluess ◽

Mevluet Sungu ◽

...

Keyword(s):

Range Of Motion ◽

Internal Rotation ◽

Computer Aided Design ◽

External Rotation ◽

Patient Specific ◽

Computational Framework ◽

Total Hip ◽

Total Hip Replacements ◽

Significant Difference ◽

Hip Replacements

The calculation of range of motion (ROM) is a key factor during preoperative planning of total hip replacements (THR), to reduce the risk of impingement and dislocation of the artificial hip joint. To support the preoperative assessment of THR, a magnetic resonance imaging (MRI)-based computational framework was generated; this enabled the estimation of patient-specific ROM and type of impingement (bone-to-bone, implant-to-bone, and implant-to-implant) postoperatively, using a three-dimensional computer-aided design (CAD) to visualize typical clinical joint movements. Hence, patient-specific CAD models from 19 patients were generated from MRI scans and a conventional total hip system (Bicontact® hip stem and Plasmacup® SC acetabular cup with a ceramic-on-ceramic bearing) was implanted virtually. As a verification of the framework, the ROM was compared between preoperatively planned and the postoperatively reconstructed situations; this was derived based on postoperative radiographs (n = 6 patients) during different clinically relevant movements. The data analysis revealed there was no significant difference between preoperatively planned and postoperatively reconstructed ROM (∆ROM) of maximum flexion (∆ROM = 0°, p = 0.854) and internal rotation (∆ROM = 1.8°, p = 0.917). Contrarily, minor differences were observed for the ROM during maximum external rotation (∆ROM = 9°, p = 0.046). Impingement, of all three types, was in good agreement with the preoperatively planned and postoperatively reconstructed scenarios during all movements. The calculated ROM reached physiological levels during flexion and internal rotation movement; however, it exceeded physiological levels during external rotation. Patients, where implant-to-implant impingement was detected, reached higher ROMs than patients with bone-to-bone impingement. The proposed framework provides the capability to predict postoperative ROM of THRs.

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An Innovative and Cost-Advantage CAD Solution for Cubitus Varus Surgical Planning in Children

Applied Sciences ◽

10.3390/app11094057 ◽

2021 ◽

Vol 11 (9) ◽

pp. 4057

Author(s):

Leonardo Frizziero ◽

Gian Maria Santi ◽

Christian Leon-Cardenas ◽

Giampiero Donnici ◽

Alfredo Liverani ◽

...

Keyword(s):

Computer Aided Design ◽

Low Cost ◽

Cost Effective ◽

Varus Deformity ◽

Patient Specific ◽

Cubitus Varus ◽

Surgical Guide ◽

Traditional Procedure ◽

Custom Made ◽

Patient Specific Instruments

The study of CAD (computer aided design) modeling, design and manufacturing techniques has undergone a rapid growth over the past decades. In medicine, this development mainly concerned the dental and maxillofacial sectors. Significant progress has also been made in orthopedics with pre-operative CAD simulations, printing of bone models and production of patient-specific instruments. However, the traditional procedure that formulates the surgical plan based exclusively on two-dimensional images and interventions performed without the aid of specific instruments for the patient and is currently the most used surgical technique. The production of custom-made tools for the patient, in fact, is often expensive and its use is limited to a few hospitals. The purpose of this study is to show an innovative and cost-effective procedure aimed at prototyping a custom-made surgical guide for address the cubitus varus deformity on a pediatric patient. The cutting guides were obtained through an additive manufacturing process that starts from the 3D digital model of the patient’s bone and allows to design specific models using Creo Parametric. The result is a tool that adheres perfectly to the patient’s bone and guides the surgeon during the osteotomy procedure. The low cost of the methodology described makes it worth noticing by any health institution.

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