Residents Perfect Neurosurgery Skills with U of M Simulators

If life or death balanced on the edge of your scalpel, you’d want to feel as confident as possible about making the cut, right?

Neurosurgeons do this type of work regularly, performing some of the most delicate and precarious surgical operations on the brain and spine.

As residents, they usually practice on cadavers, followed by extensive operating room observations of procedures performed by more skilled practitioners. Eventually they’re allowed to operate on live patients, albeit under the watchful supervision of more experienced neurosurgeons until they’ve mastered the technique.

Unfortunately, cadavers aren’t ideal to practice some procedures on, due to tissue deterioration and availability. Virtual-reality simulators can allow students to get a feel for procedures, but their fidelity and high costs are prohibitive.

Solving the problem of how to better prepare neurosurgery students for real-life applications is something that neurosurgeons and engineers at the University of Michigan have been working toward.  With the help of a $75,000 Blue Cross Blue Shield of Michigan Foundation grant, the U of M team developed two physical and anatomically accurate neurosurgery simulators for two procedures:

  • Ventriculostomy is typically performed under emergency conditions, inserting a catheter into the brain to relieve pressure in cases of traumatic brain injury, hemorrhagic stroke or hydrocephalus.
  • Endonasal drilling is performed to surgically resect tumors. A small drill is routed through the nose to reach the anterior skull base.

Albert Shih is a U of M professor specializing in mechanical engineering, biomedical engineering and integrative systems and design. Along with colleagues in neurosurgery including Drs. Oren Sagher, Steven Sullivan, Luis Savastano and Anthony Wang and Prof. Bruce Tai from engineering, he’s worked to develop simulators with materials that mimic the brain, soft tissue and bone involved in these complex neurosurgical operations.

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A ventriculostomy simulator. (Courtesy photo)

These simulators can transform the way students learn. Instead of “see one, do one, teach one,” Shih said “see one, do many with simulators, do one, then teach,” is a model that can lead to higher confidence for surgeons and patients.

“That’s what we hope to accomplish, and the funding support from the Foundation really makes a difference because no other funding sources, not the National Science Foundation nor the National Institutes of Health, will support this type of collaborative research that is not deemed to be fundamental,” he said.

Savastano is a neurosurgeon and championed the use of the ventriculostomy simulator at a regional neurosurgical bootcamp in Chicago. He said the simulator provides a very realistic practice experience for students. Pressurized fluid inside mimics a real brain and different materials for the mock skull and brain make the experience of “operating” feel like the real thing. The model can also be used with all instruments, an important distinction since surgeons want to use the tools they’re comfortable with and that they’ll be using during the actual procedure.

Savastano said ultimately it’s better to troubleshoot with a simulator than a real patient.

“It’s very nice to have a simulator with which you can practice all the steps required to do a surgical procedure,” he said.

Shih, Savastano, Tai and their colleagues were published for their work on the ventriculostomy and endonasal drilling simulators in the Journal of Neurosurgery. Artisan Medical Displays in Zeeland, Michigan is contracted to manufacture the simulators for training hospitals and other institutions.

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Main image photo credit: Phalinn Ooi

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