Artikel
Navigation assisted virtual interventions for neurosurgical training
Virtuelle navigationsgestützte Eingriffe zur neurochirurgischen Ausbildung
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Autoren
Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
To evaluate the suitability of a 3D neuronavigation system for virtual puncture of the lateral ventricles and intracerebral haemorrhage in a cadaver model.
Methods
A cadaver head underwent standard CT of the neurocranium. After application of navigation markers (screw marker system, Stryker Leibinger) a spiral CT scan was performed (1mm slice thickness). Data were loaded onto the neuronavigation system (Stryker Navigation System NEURO). A modified reference device (skull mount tracker) was directly fixed on the skull in order to avoid the need for rigid head fixation. The head was positioned on a head ring and a ventricular puncture was planned by using the standard CT scan data. Ventricular puncture was simulated by placing the tip of the navigation pointer on the anticipated entry point with the tilt estimated by the trainee on basis of traditional anatomical landmarks. The depth of puncture was then calculated by the trainee. The position of the tip of the virtual catheter (virtual target) was documented by editing the virtual tip extension as specified and freezing the actual image on the navigation system. The Navigation screen, which was not visible until that point, was finally revealed to the trainee to verify the position of the catheter tip. The distance of the virtual target to the anatomical target point was measured digitally and stored. 20 surgeons of our neurosurgical department were included into the study. 20 punctures were performed at 4 different time points.
Results
The participants of the study carried out a total of 400 virtual punctures of the lateral ventricles and an intracerebral haemorrhage in order to learn the technique or to improve their capabilities. The results registered showed a significant improvement of the distances to the target point of the last 5 punctures compared to the first 5.
Conclusions
Virtual training of lateral ventricle and intracerebral haemorrhage puncture using a neuronavigation system improves the precision of catheter placement.