Endoscopic skull base training using 3D printed models with pre-existing pathology
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Endoscopic base of skull surgery has been growing in acceptance in the recent past due to improvements in visualisation and micro instrumentation as well as the surgical maturing of early endoscopic skull base practitioners. Unfortunately, these demanding procedures have a steep learning curve. A physical simulation that is able to reproduce the complex anatomy of the anterior skull base provides very useful means of learning the necessary skills in a safe and effective environment. This paper aims to assess the ease of learning endoscopic skull base exposure and drilling techniques using an anatomically accurate physical model with a pre-existing pathology (i.e., basilar invagination) created from actual patient data. Five models of a patient with platy-basia and basilar invagination were created from the original MRI and CT imaging data of a patient. The models were used as part of a training workshop for ENT surgeons with varying degrees of experience in endoscopic base of skull surgery, from trainees to experienced consultants. The surgeons were given a list of key steps to achieve in exposing and drilling the skull base using the simulation model. They were then asked to list the level of difficulty of learning these steps using the model. The participants found the models suitable for learning registration, navigation and skull base drilling techniques. All participants also found the deep structures to be accurately represented spatially as confirmed by the navigation system. These models allow structured simulation to be conducted in a workshop environment where surgeons and trainees can practice to perform complex procedures in a controlled fashion under the supervision of experts.
KeywordsBase of skull surgery Odontoid ENT-ORL Simulation Training Clinical skills 3D rapid prototyping
This work was supported by University of Malaya via the High Impact Research Grant (H-50001-00-A000026) granted to Professor Vicknes Waran. Neither University Malaya nor the grant committee had a direct role in the study design; collection, analysis or interpretation of data; writing of the report; and the decision to submit this paper for publication.
Conflict of interest
Video 1: Demonstration of odontoid drilling in the model (MPG 7596 kb)
- 5.Berhouma M, Baidya NB, Ismaïl AA, Zhang J, Ammirati M (2013) Shortening the learning curve in endoscopic endonasal skull base surgery: a reproducible polymer tumor model for the trans-sphenoidal trans-tubercular approach to retro-infundibular tumors. Clin Neurol Neurosurg 115(9):1635–1641. doi: 10.1016/j.clineuro.2013.02.013 Epub 2013 Mar 5CrossRefPubMedGoogle Scholar
- 12.Accreditation Council for Graduate Medical Education (ACGME) (2011) Common program requirements. http://www.acgme.org/acgmeweb/Portals/0/dh_dutyhoursCommonPR07012007pdf
- 14.Waran V, Devaraj P, Hari Chandran T, Muthusamy KA, Rathinam AK, Balakrishnan YK, Tung TS, Raman R, Rahman ZA (2012) Three-dimensional anatomical accuracy of cranial models created by rapid prototyping techniques validated using a neuronavigation station. J Clin Neurosci 19(4):574–577. doi: 10.1016/j.jocn.2011.07.031 Epub 2012 Feb 3CrossRefPubMedGoogle Scholar
- 15.Waran V, Menon R, Pancharatnam D, Rathinam AK, Balakrishnan YK, Tung TS, Raman R, Prepageran N, Chandran H, Rahman ZA (2012) The creation and verification of cranial models using three-dimensional rapid prototyping technology in field of transnasal sphenoid endoscopy. Am J Rhinol Allergy 26(5):e132–e136. doi: 10.2500/ajra.2012.26.3808 CrossRefPubMedGoogle Scholar
- 17.Chen G, Ling F (2010) A new plastic model of endoscopic technique training for endonasal transsphenoidal pituitary surgery. Chin Med J (Engl) 123(18):2576–2579Google Scholar