Development of 3D printed interactive training models for the placement of external ventricular drainage
Michael Kosterhon (Mainz), Matthias Gielisch (Mainz), Julian Graef (Mainz), Florian Ringel (Mainz)
The placement of an external ventricular drain (EVD) is one of the most performed interventions in cranial neurosurgery to treat hydrocephalus or increased intracranial pressure. In many emergency situations it depicts the first but often lifesaving treatment and therefore is one of the first skills young neurosurgeons have to learn. However the correct placement relies heavily on experience as it is conducted often manually. The insertion point and the direction of insertion are determined by anatomical landmarks with many interindividual variations. Therefore this procedure is prone for failures such as misplacement especially for beginners. We here suggest a simple 3D printed EVD training model giving the opportunity to improve these manual skills.
We used CT scans of the heads of 3 different patients being treated with shunt or EVD with slit ventricles, normal ventricle size and enlarged ventricles. Next the CT-scans were segmented with a threshold of 20 hounsfield units to extract the skin surface. The extracted head then was angulated with the Frankfurt line to be 45° over the horizontal line. All models then were manufactured on a stereolithografic printer. Each model was fixed on a table and infrared reflectors as optical reference base were installed. The CT scan for each head was uploaded to a surgical navigation system and the models were registered to the system by using predefined anatomical landmarks. With a navigation pointer acting as the EVD to be placed, interactive feedback on entry point, direction and depth of insertion could be visualized.
All 3 models could be reproduced in the correct size and shape. The registration procedure was quick and convenient. There was no major registration error. By touching the skin surface and predefined anatomical landmarks we found a precise match of virtual model in the navigation system with its 3D printed real representation. Entry and target points could be stored for further evaluations and comparison with other trainees.
The proposed method of creating 3D printed models for the placement of EVDs in combination with a navigation system could help to train especially young neurosurgeons and may improve accuracy of placement in the real clinic setting which is subject of further investigations.
We use cookies on our website. Cookies are small (text) files that are created and stored on your device (e.g., smartphone, notebook, tablet, PC). Some of these cookies are technically necessary to operate the website, other cookies are used to extend the functionality of the website or for marketing purposes. Apart from the technically necessary cookies, you are free to allow or not allow cookies when visiting our website.