Endoscopic third ventriculostomy is a procedure used to treat hydrocephalus by making a perforation in the floor of the third ventricle of the brain under endoscopic guidance. We report on our initial experience in developing an endoscopic third ventriculostomy simulator for neurosurgery residents, including the definition of the simulation content and integration on NeuroTouch, a simulator for microneurosurgery training. The simulator includes exercises in which the trainee is asked to choose the location of the burr hole and the orientation of the trajectory to the foramen of Monro, or is required to find the third ventricle with a neuro-endoscope and perforate its floor. The simulator provides feedback on trainee performance either graphically or using quantitative metrics. The simulator allows easily switching from endoscopic third ventriculostomy mode to microscopic craniotomy mode using a retractable stereoscope based on a single screen and mirrors, detachable plastic heads, and quick-connect tool handles to give more realistic haptic feedback.
SeymourNEGallagherAGRomanSA. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg2002; 236: 458–464.
4.
GurusamyKAggarwalRPalaniveluL. Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopic surgery. Br J Surg2008; 95: 1088–1097.
5.
HanscomR. Medical simulation from an insurer’s perspective. Acad Emerg Med2008; 15: 984–987.
6.
RodwinMAChangHJOzaetaMM. Malpractice premiums in Massachusetts, a high-risk state: 1975 to 2005. Health Aff2008; 27: 835–844.
7.
StoneSBernsteinM. Prospective error recording in surgery: an analysis of 1108 elective neurosurgical cases. Neurosurgery2007; 60: 1075–1080.
8.
PerssonEKHagbergGUvebrantP. Hydrocephalus prevalence and outcome in a population-based cohort of children born in 1989–1998. Acta Paediatr2005; 94: 726–732.
9.
LaurenceKMCoatesS. The natural history of hydrocephalus. Arch Dis Child1962; 37: 345–362.
10.
BourasTSgourosS. Complications of endoscopic third ventriculostomy. J Neurosurg Pediatr2011; 7: 643–649.
11.
ErsahinYArslanD. Complications of endoscopic third ventriculostomy. Child Nerv Syst2008; 24: 943–948.
12.
QuestDO. Naval aviation and neurosurgery: traditions, commonalities, and lessons learned. The 2007 presidential address. J Neurosurg2007; 107: 1067–1073.
13.
ApuzzoMLJElderJBLiuCY. The metamorphosis of neurological surgery and the reinvention of the neurosurgeon. Neurosurgery2009; 64: 788–795.
ParikhSSChanSAgrawalSK. Integration of patient-specific paranasal sinus computed tomographic data into a virtual surgical environment. Am J Rhinol Allergy2009; 23: 442–447.
16.
TolsdorffBPommertAHöhneKH. Virtual reality: a new paranasal sinus surgery simulator. Laryngoscope2010; 120: 420–406.
LarsenOVHaaseJØstergaardLR. The virtual brain project. Stud Health Technol Inform2001; 81: 256–262.
19.
LemoleGMJrBanerjeePPLucianoC. Virtual reality in neurosurgical education: part-task ventriculostomy simulation with dynamic visual and haptic feedback. Neurosurgery2007; 61: 142–149.
20.
FreudensteinDBartzDSkalejM. New virtual system for planning of neuroendoscopic interventions. Comput Aided Surg2001; 6: 77–84.
21.
BrownNNatsupakpongSJohannsenS. Virtual environment-based training simulator for endoscopic third ventriculostomy. Stud Health Tech Informat2006; 119: 73–75.
22.
ÇakmakHMaassHTrantakisC. Haptic ventriculostomy simulation in a grid environment. Comput Animation Virtual Worlds2009; 20: 25–38.
23.
GanjuAAounSGDaouMR. The role of simulation in neurosurgical education: a survey of 99 United States neurosurgery program directors. World Neurosurgery, 24November2012.
24.
SeldenNRBarbaroNOrigitanoTC. Fundamental skills for entering neurosurgery residents: report of a Pacific region “boot camp” pilot course, 2009. Neurosurgery2011; 68: 759–764.
25.
SeldenNROrigitanoTCBurchielKJ. A national fundamentals curriculum for neurosurgery PGY1 residents: the 2010 Society of Neurological Surgeons boot camp courses. Neurosurgery2012; 70: 971–981.
26.
LobelDARezaiAR. Frontiers in neurosurgery: simulation in resident education. The future of neurosurgical education. CNS Q2011; Summer: 4–6.
27.
DelormeSLarocheDDiRaddoR. NeuroTouch: a physics-based virtual simulator for cranial microneurosurgery training. Neurosurgery2012; 71: 32–42.
28.
ChoudhuryNGélinas-PhaneufNDelormeS. Fundamentals of neurosurgery: virtual reality tasks for training and evaluation of technical skills. World Neurosurgery, 22November2012.
HajiFADubrowskiADrakeJM. Simulation training for neuroendoscopy: a Canadian national needs assessment survey. J Neurosurg2013; 118: 250–257.
31.
KannerAHopfNJGrunertP. The “optimal” burr hole position for endoscopic third ventriculostomy: results from 31 stereotactically guided procedures. Minim Invasive Neurosurg2000; 43: 187–189.
32.
KnausHAbbushiAHoffmannK. Measurements of burr-hole localization for endoscopic procedures in the third ventricle in children. Child Nerv Syst2009; 25: 293–299.
33.
DuffnerFSchiffbauerHGlemserD. Anatomy of the cerebral ventricular system for endoscopic neurosurgery: a magnetic resonance study. Acta Neurochirur2003; 145: 359–368.
34.
HellwigDGrotenhuisJATirakotaiW. Endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurg Rev2005; 28: 1–34.
35.
HornBKP. Closed-form solution of absolute orientation using unit quaternions. JOSA A1987; 4: 629–642.
36.
FungYC. Biomechanics: mechanical properties of living tissue. 2nd ed.New York: Springer, 1993.
37.
ZienkiewczOCTaylorRL. The finite element method for solid and structural mechanics. 6th ed.Oxford: Butterworth-Heinemann; 2005.
38.
MoraVJiangDBrooksR. A computer model of soft tissue interaction with a surgical aspirator. Med Image Comput Comput Assist Interv2009; 12: 51–58.
39.
NeubauerABrooksRBrouwerI. Haptic collision handling for simulation of transnasal surgery. Comput Animation Virtual Worlds2013; 24(2): 127–141.
40.
RohdeVKrombachGAStruffertT. Virtual MRI endoscopy: detection of anomalies of the ventricular anatomy and its possible role as a presurgical planning tool for endoscopic third ventriculostomy. Acta Aeurochir (Wien)2001; 143: 1085–1091.
