Development of a 3D Printed Brain Model with Vasculature for Neurosurgical Procedure Visualisation and Training

3-Dimensional printing and bioprinting in neurological sciences: applications in surgery, imaging, tissue engineering, and pharmacology and therapeutics

The rapid evolution of three-dimensional printing (3DP) has significantly impacted the medical field. In neurology for instance, 3DP has been pivotal in personalized surgical planning and education. Additionally, it has facilitated the creation of implants, microfluidic devices, and optogenetic probes, offering substantial implications for medical and research applications. Additionally, 3D printed nasal casts are showing great promise for targeted brain drug delivery. 3DP has also aided in creating 3D "phantoms" aligning with advancements in neuroimaging, and in the design of intricate objects for investigating the neurobiology of sensory perception. Furthermore, the emergence of 3D bioprinting (3DBP), a fusion of 3D printing and cell biology, has created new avenues in neural tissue engineering. Effective and ethical creation of tissue-like biomimetic constructs has enabled mechanistic, regenerative, and therapeutic evaluations. While individual reviews have explored the applications of 3DP or 3DBP, a comprehensive review encompassing the success stories across multiple facets of both technologies in neurosurgery, neuroimaging, and neuro-regeneration has been lacking. This review aims to consolidate recent achievements of both 3DP and 3DBP across various neurological science domains to encourage interdisciplinary research among neurologists, neurobiologists, and engineers, in order to promote further exploration of 3DP and 3DBP methodologies to novel areas of neurological science research and practice.

Evaluating the Educational Impact of 3D-Printed Models in Cervical Laminoplasty Training: A Survey-Based Study

Background and objective The complexities of spinal surgery, particularly the intricacies of cervical pathology, demand precision and expertise in surgical interventions. Cervical laminoplasty is a procedure that requires meticulous execution and a profound understanding of delicate anatomical structures. Recognizing the limitations of traditional training methods, this study highlights the transformative impact of integrating 3D modeling and printing technologies into medical education. These technologies provide an immersive, interactive, and highly detailed training platform, enabling aspiring surgeons to visualize, dissect, and practice procedures in a risk-free environment. Beyond education, 3D models enhance patient-doctor communication, enable precise preoperative planning, facilitate custom implant design, and support a personalized approach to spinal surgery. Collectively, these advancements hold the promise of reducing surgical errors and improving outcomes. Materials and methods Thirty-eight participants, including neurosurgeons, residents, and medical doctors, were enrolled in this study. High-resolution CT scans, obtained with informed consent to ensure confidentiality and ethical compliance, were used to create the 3D models. These models, printed with polylactic acid (PLA) filament and refined through post-processing, achieved high anatomical accuracy and quality. The training program combined lectures, live demonstrations, and hands-on sessions with 3D models. Participants' experiences and perceptions were evaluated through a survey, focusing on the models' utility and realism in advancing surgical skills. Results The participants overwhelmingly praised the 3D models for their utility in helping to understand cervical laminoplasty concepts and enhancing their learning compared to traditional methods. The models were particularly valued for their accurate representation of anatomical structures and improved visualization of surgical steps. Notably, 81.6% of participants found the models extremely beneficial in planning surgical approaches. The survey results unanimously highlighted the transformative potential of 3D models in medical education. Participants strongly recommended their integration into training programs and preoperative planning processes, emphasizing their ability to elevate the learning experience and improve surgical preparedness. Conclusions Our findings show that 3D modeling significantly enhances training in cervical laminoplasty by providing superior learning tools and improving anatomical visualization compared to conventional methods. The unanimous endorsement from participants underscores the adaptability and precision of 3D models in medical education and preoperative planning. As an indispensable resource in modern medical training, these models represent a pivotal advancement in preparing surgeons for the complexities of spinal surgery.

Development and Validation of a Neurosurgical Phantom for Simulating External Ventricular Drain Placement

This study aimed to develop and validate a cost-effective, customizable patient-specific phantom for simulating external ventricular drain placement, combining image segmentation, 3-D printing and molding techniques. Two variations of the phantom were created based on patient MRI data, integrating a realistic skin layer with anatomical landmarks, a 3-D printed skull, an agarose polysaccharide gel brain, and a ventricular cavity. To validate the phantom, 15 neurosurgeons, residents, and physician assistants performed 30 EVD placements. The effectiveness of the phantom as a training tool was assessed through a standardized user experience questionnaire, which evaluated the physical attributes, realism, and overall satisfaction. The mechanical properties of the phantom brain were quantified by measuring catheter insertion forces using a linear force tester to compare them to those experienced in real brain tissue. The study participants successfully completed EVD placements with a 76.7% optimal placement rate, which aligns with rates observed in clinical practice. Feedback highlighted the anatomical accuracy of the phantom and its value in enhancing surgical skills, though it also identified areas for improvement, particularly in the realism of the skin layer. Mechanical testing demonstrated that the insertion forces required were comparable to those encountered in actual brain tissue. The developed phantom offers a realistic, low-cost, and adaptable model for EVD simulation. This tool is particularly beneficial for both training and research, with future enhancements planned to improve the realism of the skin and incorporate more anatomical features to increase the fidelity of the simulation.

The application of novel techniques in ophthalmology education

This paper synthesizes recent advances of technologies in ophthalmology education. Advancements in three-dimensional technology are revolutionizing ophthalmology education by enhancing the visualization, understanding, and retention of complex anatomical and pathological concepts. In addition to physical models, artificial intelligence and virtual reality are emerging as significant tools. A systematic search of PubMed was carried out, with a search date from inception to 01/05/2024. A total of 6,686 articles were screened, of which 6,470 were excluded following abstract review. After reading the remaining 216 articles in full, a further 186 were excluded. A total of 30 original articles were included in the review. This review underscores the transformative impact of novel technology in ophthalmology education, offering innovative solutions to enhance learning, surgical training, and diagnostic skills. Further research and development in this field hold promise for continued improvements in ophthalmology education and practice.

Correlation of Edema/Tumor Index With Histopathological Outcomes According to the WHO Classification of Cranial Tumors

BACKGROUND

Metastatic brain tumors are a prevalent challenge in neurosurgery, with vasogenic edema being a significant consequence of these lesions. Despite the critical role of peritumoral edema in prognosis and patient outcomes, few studies have quantified its diagnostic and prognostic implications. This study aims to evaluate the correlation between the edema/tumor index (ETI) and histopathological outcomes according to the 2021 WHO classification of cranial tumors.

METHODOLOGY

We conducted a retrospective analysis of Digital Imaging and Communications in Medicine (DICOM)-format magnetic resonance imaging (MRI) data from May 2023 to May 2024, applying manual 3D volumetric segmentation using Image Tool Kit-SNAP (ITK-SNAP, version 3.8.0, University of Pennsylvania) software. The ETI was calculated by dividing the volume of peritumoral edema by the tumor volume. The study included 60 patients, and statistical analyses were performed to assess the correlation between ETI and tumor histopathology, including Receiver Operating Characteristic (ROC) curve analysis for cutoff points.

RESULTS

A total of 60 patients were included in the study, with 27 males (45%) and 33 females (55%). The average tumor volume measured by 3D segmentation was 46.9 cubic centimeters (cc) (standard deviation [SD] ± 25.6), and the average peritumoral edema volume was 79 cc (SD ± 37.5) for malignant tumors. The ETI was calculated for each case. Malignant tumors (WHO grades 3 and 4) had a mean ETI of 1.6 (SD ± 1.2), while non-malignant tumors (WHO grades 1 and 2) had a mean ETI of 1.2 (SD ± 1.1), but this difference was not statistically significant (P = 0.51). ROC curve analysis for the ETI did not provide a reliable cutoff point for predicting tumor malignancy (area under the curve [AUC] = 0.59, P = 0.20). Despite the larger edema volume observed in malignant tumors, the ETI did not correlate significantly with the histopathological grade.

CONCLUSIONS

This study found no significant correlation between the ETI and the histopathological grade of brain tumors according to the 2021 WHO classification. While malignant tumors were associated with larger volumes of both tumor and peritumoral edema, the ETI did not prove to be a reliable predictor of tumor malignancy. Therefore, the ETI should not be used as a standalone metric for determining tumor aggressiveness or guiding clinical decision-making. Further studies with larger cohorts are required to better understand the potential prognostic value of the ETI in brain tumors.

Pioneering Augmented and Mixed Reality in Cranial Surgery: The First Latin American Experience

INTRODUCTION

Augmented reality (AR) and mixed reality (MR) technologies have revolutionized cranial neurosurgery by overlaying digital information onto the surgical field, enhancing visualization, precision, and training. These technologies enable the real-time integration of preoperative imaging data, aiding in better decision-making and reducing operative risks. Despite challenges such as cost and specialized training needs, AR and MR offer significant benefits, including improved surgical outcomes and personalized surgical plans based on individual patient anatomy.

MATERIALS AND METHODS

This study describes three intracranial surgeries using AR and MR technologies at Hospital Ángeles Universidad, Mexico City, in 2023. Surgeries were performed with VisAR software 3 version and Microsoft HoloLens 2, transforming DICOM images into 3D models. Preoperative MRI and CT scans facilitated planning, and radiopaque tags ensured accurate image registration during surgery. Postoperative outcomes were assessed through clinical and imaging follow-up.

RESULTS

Three intracranial surgeries were performed with AR and MR assistance, resulting in successful outcomes with minimal postoperative complications. Case 1 achieved 80% tumor resection, Case 2 achieved near-total tumor resection, and Case 3 achieved complete lesion resection. All patients experienced significant symptom relief and favorable recoveries, demonstrating the precision and effectiveness of AR and MR in cranial surgery.

CONCLUSIONS

This study demonstrates the successful use of AR and MR in cranial surgery, enhancing precision and clinical outcomes. Despite challenges like training and costs, these technologies offer significant benefits. Future research should focus on long-term outcomes and broader applications to validate their efficacy and cost-effectiveness in neurosurgery.

Wallenberg Syndrome Secondary to Vertebrobasilar Aneurysm Associated With Subclavian Steal Syndrome

Wallenberg syndrome, also known as lateral medullary syndrome, is a rare condition affecting the vertebrobasilar circulation, causing symptoms such as vertigo, nystagmus, dysarthria, and hemifacial weakness. Typically linked to ischemic strokes, it can also arise from vertebrobasilar aneurysms. In rare cases, subclavian steal syndrome (SSS), involving retrograde flow in the vertebral artery due to subclavian stenosis, complicates the picture, as observed in this case of a 66-year-old woman with both conditions and a vertebrobasilar aneurysm. This study was conducted at the Neurosurgery Department of Centro Médico Nacional 20 de Noviembre, Mexico City. The patient, a 66-year-old woman with hypertension and chronic smoking, presented with vertigo, diplopia, and quadriparesis. Imaging revealed a vertebrobasilar aneurysm and SSS. Despite recommendations for further invasive studies, the patient declined angiography and therapeutic interventions, opting for voluntary discharge without treatment. This case underscores the rare association of Wallenberg syndrome with a vertebrobasilar aneurysm and SSS. Hemodynamic stress from retrograde vertebral artery flow likely contributed to aneurysm formation. Advanced imaging is vital for diagnosis, and while the patient refused treatment, multidisciplinary management, including future innovations such as three-dimensional printing and endovascular techniques, holds promise for improving outcomes in such complex cases.

Transpedicular Corpectomy in Minimally Invasive Surgery for Metastatic Spinal Cord Compression: A Single-Center Series

Introduction The role of separation surgery in managing symptomatic spinal metastases has been increasing in recent years, and it represents a crucial part of the definitive management of this condition. Methods We report on a series of seven patients treated at the National Cancer Institute in Mexico using minimally invasive approaches to perform transpedicular corpectomy. The goal was to obtain a margin of tumor-free tissue, enabling the completion of oncological treatment with radiotherapy. Results We collected data from six cases. The mean age was 61.2 years. Surgical outcomes were good in 83.3% of patients. Ranging from minimally invasive instrumentations to total or partial corpectomies, these procedures achieved their intended function of generating healthy neural tissue free of tumor. This ensures that the radiation gradient does not affect this tissue. No surgical complications were reported. The objective of these surgeries was to establish a radiotherapy or radiosurgery regimen as soon as possible, thereby improving patients' quality of life (QoL). Conclusions Low-cost transpedicular corpectomy via minimally invasive surgery (MIS) is a safe and effective method that meets the goals of separation surgery. However, prospective studies are needed to directly compare open techniques with minimally invasive methods.

The current application of 3D printing simulator in surgical training

In the rapidly evolving field of medical education, the integration of innovative technologies has become paramount to enhance the training and proficiency of future surgeons. Among these advancements, the application of 3D printing technology stands out as a useful tool in surgical training. The advantages of the 3D printing model include customization, re-usability and low-cost. The average cost of the 3D printing simulators was between $100-1000. However, there were extremely high potential labor cost during the 3D printing that hadn't been calculated into. Additionally, in the current stage, the 3D printing simulator still have specific limitations. The most mentioned limitation was poor haptic feedback of the simulators, which was very important during the surgical training, since it is the key element for junior doctors to master practical procedures. Also, some simulators didn't possess the integrated and elaborate structure as the human tissue, hence not the whole surgical procedures can be practiced by the trainees, and further improvement should be made. Although there are shortages, many studies have proved that 3D printing simulator can effectively reduce learning curves and is useful to enhance the trainees' surgical skills.

Clinical Outcome After Epidural Spinal Cord Stimulation in Patients With Severe Traumatic Brain Injury

INTRODUCTION

 Epidural spinal cord stimulation is a minimally invasive procedure with a growing list of indications. It has a good safety profile and analgesic effect, reduces the severity of spasticity, and activates various brain regions. The purpose of this study is to evaluate the clinical outcome of epidural spinal cord stimulation in patients with spastic syndrome and chronic disorders of consciousness resulting from severe traumatic brain injury (sTBI).

METHODS

Between 2021 and 2023, an epidural spinal cord stimulation test was performed in 34 patients with central paresis, severe hypertonia, and chronically altered consciousness following sTBI. The severity of spastic syndrome was assessed using a modified Ashworth scale. All patients underwent implantation of a cylindrical eight-contact test epidural electrode at C3-C5 cervical level, followed by neurostimulation and selection of individual modes. Tonic stimulation at a frequency of 60 Hz, "burst" mode, or a combination of the two was used.

RESULTS

 Epidural spinal cord stimulation was administered for an average of 4 ± 1.5 days, with tonic stimulation mode applied in 15 (44.1%) patients, "burst" mode in 10 (29.4%), and a combination of two in nine (26.5%) patients. A reduction in spasticity with clinical improvement was observed in 21 patients (61.8%). The Ashworth scale scores for distal and proximal upper extremities decreased from 3 points to 2.5 points and from 3 points to 2 points, respectively. This was significant in the right upper limbs (p = 0.0152 distally and p = 0.0164 proximally). Significant improvements were also seen in the lower extremities. Active movements in paretic limbs increased or appeared in 12 patients (35.3%), while a heightened level of consciousness was observed in six patients (17.6%). Permanent neurostimulator implantation was performed in 12 patients (35.3%), with no reported surgical complications.

CONCLUSION

 Epidural spinal cord stimulation shows promise as an invasive rehabilitation method for patients with sTBI sequelae. Its use reduced the severity of spastic syndrome in over half of patients and increased active movements in paretic limbs in over a third. Notably, neuromodulation at the cervical level yielded pronounced effects on the upper extremities, both proximally and distally. Findings regarding consciousness level improvement are particularly intriguing but warrant further validation through randomized trials.

Integrating Augmented Reality in Spine Surgery: Redefining Precision with New Technologies

INTRODUCTION

The integration of augmented reality (AR) in spine surgery marks a significant advancement, enhancing surgical precision and patient outcomes. AR provides immersive, three-dimensional visualizations of anatomical structures, facilitating meticulous planning and execution of spine surgeries. This technology not only improves spatial understanding and real-time navigation during procedures but also aims to reduce surgical invasiveness and operative times. Despite its potential, challenges such as model accuracy, user interface design, and the learning curve for new technology must be addressed. AR's application extends beyond the operating room, offering valuable tools for medical education and improving patient communication and satisfaction.

MATERIAL AND METHODS

A literature review was conducted by searching PubMed and Scopus databases using keywords related to augmented reality in spine surgery, covering publications from January 2020 to January 2024.

RESULTS

In total, 319 articles were identified through the initial search of the databases. After screening titles and abstracts, 11 articles in total were included in the qualitative synthesis.

CONCLUSION

Augmented reality (AR) is becoming a transformative force in spine surgery, enhancing precision, education, and outcomes despite hurdles like technical limitations and integration challenges. AR's immersive visualizations and educational innovations, coupled with its potential synergy with AI and machine learning, indicate a bright future for surgical care. Despite the existing obstacles, AR's impact on improving surgical accuracy and safety marks a significant leap forward in patient treatment and care.

Intraoperative Ultrasound: An Old but Ever New Technology for a More Personalized Approach to Brain Tumor Surgery

BACKGROUND

Although the use of transcranial ultrasound dates to the mid-20th century, the main purpose of this research work is to standardize its use in the resection of brain tumors. This is due to its wide availability, low cost, lack of contraindications, and absence of harmful effects for the patient and medical staff, along with the possibility of real-time verification of the complete resection of tumor lesions and minimization of vascular injuries or damage to adjacent structures.

METHODS

A retrospective study was conducted from June to December 2022. The study included eight patients (three men and five women) aged between 32 and 76 years. Histological examination revealed two high-grade gliomas, one low-grade glioma, and five metastatic lesions.

RESULTS

The low-grade glioma appeared as a homogeneously echogenic structure and easily distinguishable from brain parenchyma, whereas metastases and high-grade gliomas showed higher echogenicity, being identified as malignant lesions due to areas of low echogenicity necrosis and peritumoral edema identified as a hyperechogenic structure.

CONCLUSIONS

The use of intraoperative transcranial ultrasound constitutes an important tool for neurosurgeons during tumor resection. Although it is easy to use, intraoperative ultrasound requires a relatively short learning curve and a good understanding of the fundamentals of ultrasound. Its main advantage over neuronavigation is that it is not affected by the "brain shift" phenomenon that commonly occurs during tumor resection, since the ultrasound images are updated during surgery.

Low-Cost 3D Models for Cervical Spine Tumor Removal Training for Neurosurgery Residents

BACKGROUND AND OBJECTIVES

Spinal surgery, particularly for cervical pathologies such as myelopathy and radiculopathy, requires a blend of theoretical knowledge and practical skill. The complexity of these conditions, often necessitating surgical intervention, underscores the need for intricate understanding and precision in execution. Advancements in neurosurgical training, especially with the use of low-cost 3D models for simulating cervical spine tumor removal, are revolutionizing this field. These models provide the realistic and hands-on experience crucial for mastering complex neurosurgical techniques, filling gaps left by traditional educational methods.

MATERIALS AND METHODS

This study aimed to assess the effectiveness of 3D-printed cervical vertebrae models in enhancing surgical skills, focusing on tumor removal, and involving 20 young neurosurgery residents. These models, featuring silicone materials to simulate the spinal cord and tumor tissues, provided a realistic training experience. The training protocol included a laminectomy, dural incision, and tumor resection, using a range of microsurgical tools, focusing on steps usually performed by senior surgeons.

RESULTS

The training program received high satisfaction rates, with 85% of participants extremely satisfied and 15% satisfied. The 3D models were deemed very realistic by 85% of participants, effectively replicating real-life scenarios. A total of 80% found that the simulated pathologies were varied and accurate, and 90% appreciated the models' accurate tactile feedback. The training was extremely useful for 85% of the participants in developing surgical skills, with significant post-training confidence boosts and a strong willingness to recommend the program to peers.

CONCLUSIONS

Continuing laboratory training for residents is crucial. Our model offers essential, accessible training for all hospitals, regardless of their resources, promising improved surgical quality and patient outcomes across various pathologies.

The Novel Impact of Augmented Reality and 3D Printing in the Diagnosis of Complex Acetabular Fractures: A Comparative Randomized Study in Orthopedic Residents

Augmented reality (AR) and 3D printing (3DP) are novel technologies in the orthopedic field. Over the past decade, enthusiasm for these new digital applications has driven new perspectives in improving diagnostic accuracy and sensitivity in the field of traumatology. Currently, however, it is still difficult to quantify their value and impact in the medical-scientific field, especially in the improvement of diagnostics in complex fractures. Acetabular fractures have always been a challenge in orthopedics, due to their volumetric complexity and low diagnostic reliability. Background/Objectives: The goal of this study was to determine whether these methods could improve the learning aspect and diagnostic accuracy of complex acetabular fractures compared to gold-standard CT (computed tomography). Methods: Orthopedic residents of our department were selected and divided into Junior (JUN) and Senior (SEN) groups. Associated fractures of acetabulum were included in the study, and details of these were provided as CT scans, 3DP models, and AR models displayed on a tablet screen. In a double-blind questionnaire, each resident classified every fracture. Diagnostic accuracy (DA), response time (RT), agreement (R), and confidence (C) were measured. Results: Twenty residents (JUN = 10, SEN = 10) classified five fractures. Overall DA was 26% (CT), 18% (3DP), and 29% (AR). AR-DA was superior to 3DP-DA (p = 0.048). DA means (JUN vs. SEN, respectively): CT-DA was 20% vs. 32% (p < 0.05), 3DP-DA was 12% vs. 24% (p = 0.08), and AR-DA was 28% vs. 30% (p = 0.80). Overall RT was 61.2 s (±24.6) for CT, 35.8 s (±20.1) for 3DP, and 46.7 s (±20.8) for AR. R was fairly poor between methods and groups. Overall, 3DPs had superior C (65%). Conclusions: AR had the same overall DA as CT, independent of experience, 3DP had minor differences in DA and R, but it was the fastest method and the one in which there was the most confidence. Intra- and inter-observer R between methods remained very poor in residents.

3D printed arrowroot starch-gellan scaffolds for wound healing applications

Skin, the largest organ in the body, blocks the entry of environmental pollutants into the system. Any injury to this organ allows infections and other harmful substances into the body. 3D bioprinting, a state-of-the-art technique, is suitable for fabricating cell culture scaffolds to heal chronic wounds rapidly. This study uses starch extracted from Maranta arundinacea (Arrowroot plant) (AS) and gellan gum (GG) to develop a bioink for 3D printing a scaffold capable of hosting animal cells. Field emission scanning electron microscopy (FE-SEM) and X-ray diffraction analysis (XRD) prove that the isolated AS is analogous to commercial starch. The cell culture scaffolds developed are superior to the existing monolayer culture. Infrared microscopy shows the AS-GG interaction and elucidates the mechanism of hydrogel formation. The physicochemical properties of the 3D-printed scaffold are analyzed to check the cell adhesion and growth; SEM images have confirmed that the AS-GG printed scaffold can support cell growth and proliferation, and the MTT assay shows good cell viability. Cell behavioral and migration studies reveal that cells are healthy. Since the scaffold is biocompatible, it can be 3D printed to any shape and structure and will biodegrade in the requisite time.

On the balance beam: facing the challenges of neurosurgical education in the third millennium

Background

Neurosurgery is one of the most complex and challenging areas of medicine, and it requires an ongoing commitment to education and expertise. Preparing young neurosurgeons with comprehensive education that can allow them to achieve high professional standards is a pivotal aspect of our profession.

Methods

This paper aims to analyze the current scenario in neurosurgical training identifying innovative methods that can guarantee the highest level of proficiency in our specialty.

Results

Given the inherent high-stakes nature of neurosurgical procedures, there is a significant burden of responsibility in ensuring that neurosurgical training is of the highest caliber, capable of producing practitioners who possess not just theoretical knowledge but also practical skills and well-tuned judgment.

Conclusion

Providing high-quality training is one of the major challenges that the neurosurgical community has to face nowadays, especially in low- and middle-income countries; one of the main issues to implementing neurosurgery worldwide is that the majority of African countries and many areas in Southeast Asia still have few neurosurgeons who encounter enormous daily difficulties to guarantee the appropriate neurosurgical care to their population.

Clivus-Cervical Stabilization through Transoral Approach in Patients with Craniocervical Tumor: Three Cases and Surgical Technical Note

Craniocervical tumors lead to cervical pain, instability, and neurological symptoms, reducing the quality of life. Effective surgical intervention at the craniocervical junction (CCJ) is critical and complex, involving comprehensive approaches and advanced reconstructive techniques. This study, conducted at Mexico City's National Institute of Cancerology, focused on three surgical cases that occurred in 2023 involving tumors at the CCJ: two chordomas and one prostate adenocarcinoma. We utilized a specialized technique: clivus-cervical stabilization reinforced with a polymethylmethacrylate (PMMA)-filled cervical mesh. Postoperatively, patients showed marked neurological recovery and reduced cervical pain, with enhanced Karnofsky and Eastern Cooperative Oncology Group (ECOG) scores indicating improved life quality. The surgical technique provided excellent exposure and effective tumor resection, utilizing PMMA-filled cervical mesh for stability. Tumoral lesions at the CCJ causing instability can be surgically treated through a transoral approach. This type of approach should be performed with precise indications to avoid complications associated with the procedure.

Latex vascular injection as method for enhanced neurosurgical training and skills

Background

Tridimensional medical knowledge of human anatomy is a key step in the undergraduate and postgraduate medical education, especially in surgical fields. Training simulation before real surgical procedures is necessary to develop clinical competences and to minimize surgical complications.

Methods

Latex injection of vascular system in brain and in head-neck segment is made after washing out of the vascular system and fixation of the specimen before and after latex injection.

Results

Using this latex injection technique, the vascular system of 90% of brains and 80% of head-neck segments are well-perfused. Latex-injected vessels maintain real appearance compared to silicone, and more flexible vessels compared to resins. Besides, latex makes possible a better perfusion of small vessels.

Conclusions

Latex vascular injection technique of the brain and head-neck segment is a simulation model for neurosurgical training based on real experiencing to improve surgical skills and surgical results.

Analyzing the Clinical Potential of Stromal Vascular Fraction: A Comprehensive Literature Review

Background: Regenerative medicine is evolving with discoveries like the stromal vascular fraction (SVF), a diverse cell group from adipose tissue with therapeutic promise. Originating from fat cell metabolism studies in the 1960s, SVF's versatility was recognized after demonstrating multipotency. Comprising of cells like pericytes, smooth muscle cells, and, notably, adipose-derived stem cells (ADSCs), SVF offers tissue regeneration and repair through the differentiation and secretion of growth factors. Its therapeutic efficacy is due to these cells' synergistic action, prompting extensive research. Methods: This review analyzed the relevant literature on SVF, covering its composition, action mechanisms, clinical applications, and future directions. An extensive literature search from January 2018 to June 2023 was conducted across databases like PubMed, Embase, etc., using specific keywords. Results: The systematic literature search yielded a total of 473 articles. Sixteen articles met the inclusion criteria and were included in the review. This rigorous methodology provides a framework for a thorough and systematic analysis of the existing literature on SVF, offering robust insights into the potential of this important cell population in regenerative medicine. Conclusions: Our review reveals the potential of SVF, a heterogeneous cell mixture, as a powerful tool in regenerative medicine. SVF has demonstrated therapeutic efficacy and safety across disciplines, improving pain, tissue regeneration, graft survival, and wound healing while exhibiting immunomodulatory and anti-inflammatory properties.

Clinical evaluation of augmented reality-based 3D navigation system for brachial plexus tumor surgery

BACKGROUND

Augmented reality (AR), a form of 3D imaging technology, has been preliminarily applied in tumor surgery of the head and spine, both are rigid bodies. However, there is a lack of research evaluating the clinical value of AR in tumor surgery of the brachial plexus, a non-rigid body, where the anatomical position varies with patient posture.

METHODS

Prior to surgery in 8 patients diagnosed with brachial plexus tumors, conventional MRI scans were performed to obtain conventional 2D MRI images. The MRI data were then differentiated automatically and converted into AR-based 3D models. After point-to-point relocation and registration, the 3D models were projected onto the patient's body using a head-mounted display for navigation. To evaluate the clinical value of AR-based 3D models compared to the conventional 2D MRI images, 2 senior hand surgeons completed questionnaires on the evaluation of anatomical structures (tumor, arteries, veins, nerves, bones, and muscles), ranging from 1 (strongly disagree) to 5 (strongly agree).

RESULTS

Surgeons rated AR-based 3D models as superior to conventional MRI images for all anatomical structures, including tumors. Furthermore, AR-based 3D models were preferred for preoperative planning and intraoperative navigation, demonstrating their added value. The mean positional error between the 3D models and intraoperative findings was approximately 1 cm.

CONCLUSIONS

This study evaluated, for the first time, the clinical value of an AR-based 3D navigation system in preoperative planning and intraoperative navigation for brachial plexus tumor surgery. By providing more direct spatial visualization, compared with conventional 2D MRI images, this 3D navigation system significantly improved the clinical accuracy and safety of tumor surgery in non-rigid bodies.

Enhancing microsurgical skills in neurosurgery residents of low-income countries: A comprehensive guide

Background

The main objectives of this paper are to outline the essential tools, instruments, and equipment needed to set up a functional microsurgery laboratory that is affordable for low-income hospitals and to identify cost-effective alternatives for acquiring microsurgical equipment, such as refurbished or donated instruments, collaborating with medical device manufacturers for discounted rates, or exploring local suppliers.

Methods

Step-by-step instructions were provided on setting up the microsurgery laboratory, including recommendations for the layout, ergonomic considerations, lighting, and sterilization processes while ensuring cost-effectiveness, as well as comprehensive training protocols and a curriculum specifically tailored to enhance microsurgical skills in neurosurgery residents.

Results

We explored cost-effective options for obtaining microsurgery simulators and utilizing open-source or low-cost virtual training platforms. We also included guidelines for regular equipment maintenance, instrument sterilization, and establishing protocols for infection control to ensure a safe and hygienic learning environment. To foster collaboration between low-income hospitals and external organizations or institutions that can provide support, resources, or mentorship, this paper shows strategies for networking, knowledge exchange, and establishing partnerships to enhance microsurgical training opportunities further. We evaluated the impact and effectiveness of the low-cost microsurgery laboratory by assessing the impact and effectiveness of the established microsurgery laboratory in improving the microsurgical skills of neurosurgery residents. About microsutures and microanastomosis, after three weeks of training, residents showed improvement in "surgical time" for ten separate simple stitches (30.06 vs. 8.65 min) and ten continuous single stitches (19.84 vs. 6.51 min). Similarly, there was an increase in the "good quality" of the stitches and the suture pattern from 36.36% to 63.63%.

Conclusion

By achieving these objectives, this guide aims to empower low-income hospitals and neurosurgery residents with the necessary resources and knowledge to establish and operate an affordable microsurgery laboratory, ultimately enhancing the quality of microsurgical training and patient care in low-income countries.

The Use of 3D Printed Models for Surgical Simulation of Cranioplasty in Craniosynostosis as Training and Education

BACKGROUND

The advance in imaging techniques is useful for 3D models and printing leading to a real revolution in many surgical specialties, in particular, neurosurgery.

METHODS

We report on a clinical study on the use of 3D printed models to perform cranioplasty in patients with craniosynostosis. The participants were recruited from various medical institutions and were divided into two groups: Group A (n = 5) received traditional surgical education (including cadaveric specimens) but without using 3D printed models, while Group B (n = 5) received training using 3D printed models.

RESULTS

Group B surgeons had the opportunity to plan different techniques and to simulate the cranioplasty. Group B surgeons reported that models provided a realistic and controlled environment for practicing surgical techniques, allowed for repetitive practice, and helped in visualizing the anatomy and pathology of craniosynostosis.

CONCLUSION

3D printed models can provide a realistic and controlled environment for neurosurgeons to develop their surgical skills in a safe and efficient manner. The ability to practice on 3D printed models before performing the actual surgery on patients may potentially improve the surgeons' confidence and competence in performing complex craniosynostosis surgeries.

Exploring the Potential of Three-Dimensional Imaging, Printing, and Modeling in Pediatric Surgical Oncology: A New Era of Precision Surgery

Pediatric surgical oncology is a technically challenging field that relies on CT and MRI as the primary imaging tools for surgical planning. However, recent advances in 3D reconstructions, including Cinematic Rendering, Volume Rendering, 3D modeling, Virtual Reality, Augmented Reality, and 3D printing, are increasingly being used to plan complex cases bringing new insights into pediatric tumors to guide therapeutic decisions and prognosis in different pediatric surgical oncology areas and locations including thoracic, brain, urology, and abdominal surgery. Despite this, challenges to their adoption remain, especially in soft tissue-based specialties such as pediatric surgical oncology. This work explores the main innovative imaging reconstruction techniques, 3D modeling technologies (CAD, VR, AR), and 3D printing applications through the analysis of three real cases of the most common and surgically challenging pediatric tumors: abdominal neuroblastoma, thoracic inlet neuroblastoma, and a bilateral Wilms tumor candidate for nephron-sparing surgery. The results demonstrate that these new imaging and modeling techniques offer a promising alternative for planning complex pediatric oncological cases. A comprehensive analysis of the advantages and limitations of each technique has been carried out to assist in choosing the optimal approach.

Magnetic resonance imaging based neurosurgical planning on hololens 2: A feasibility study in a paediatric hospital

Objective

The goal of this work is to show how to implement a mixed reality application (app) for neurosurgery planning based on neuroimaging data, highlighting the strengths and weaknesses of its design.

Methods

Our workflow explains how to handle neuroimaging data, including how to load morphological, functional and diffusion tensor imaging data into a mixed reality environment, thus creating a first guide of this kind. Brain magnetic resonance imaging data from a paediatric patient were acquired using a 3 T Siemens Magnetom Skyra scanner. Initially, this raw data underwent specific software pre-processing and were subsequently transformed to ensure seamless integration with the mixed reality app. After that, we created three-dimensional models of brain structures and the mixed reality environment using Unity™ engine together with Microsoft® HoloLens 2™ device. To get an evaluation of the app we submitted a questionnaire to four neurosurgeons. To collect data concerning the performance of a user session we used Unity Performance Profiler.

Results

The use of the interactive features, such as rotating, scaling and moving models and browsing through menus, provided by the app had high scores in the questionnaire, and their use can still be improved as suggested by the performance data collected. The questionnaire's average scores were high, so the overall experiences of using our mixed reality app were positive.

Conclusion

We have successfully created a valuable and easy-to-use neuroimaging data mixed reality app, laying the foundation for more future clinical uses, as more models and data derived from various biomedical images can be imported.