Abstract
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.
Similar content being viewed by others
References
Castelnuovo P, Dallan I, Battaglia P, Bignami M (2010) Endoscopic endonasal skull base surgery: past, present and future. Eur Arch Otorhinolaryngol 267(5):649–663. doi:10.1007/s00405-009-1196-0 Epub 2010 Jan 9
Shin M, Kondo K, Saito N (2012) Neuroendoscopic transnasal surgery for skull base tumors: basic approaches, avoidance of pitfalls, and recent innovations. Neurol Med Chir (Tokyo) 52(10):697–703
Wagenmann M, Schipper J (2011) The transnasal approach to the skull base. From sinus surgery to skull base surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg 10:Doc08. doi:10.3205/cto000081 Epub 2012 Apr 26
Solares CA, Ong YK, Snyderman CH (2010) Transnasal endoscopic skull base surgery: what are the limits? Curr Opin Otolaryngol Head Neck Surg 18(1):1–7. doi:10.1097/MOO.0b013e3283350035
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 5
Mori K, Yamamoto T, Oyama K, Ueno H, Nakao Y, Honma K (2008) Modified three-dimensional skull base model with artificial dura mater, cranial nerves, and venous sinuses for training in skull base surgery: technical note. Neurol Med Chir (Tokyo) 48(12):582–587 discussion 587–8
Stamm AC, Pignatari SS, Vellutini E (2006) Transnasal endoscopic surgical approaches to the clivus. Otolaryngol Clin North Am 39(3):639–656 xi
Zuckerman JD, Wise SK, Rogers GA, Senior BA, Schlosser RJ, DelGaudio JM (2009) The utility of cadaver dissection in endoscopic sinus surgery training courses. Am J Rhinol Allergy 23:218–224
Kakizawa Y, Hongo K, Rhoton AL Jr (2007) Construction of a three-dimensional interactive model of the skull base and cranial nerves. Neurosurgery 60:901–910
Ruthenbeck GS, Hobson J, Carney AS, Sloan S, Sacks R, Reynolds KJ (2013) Toward photorealism in endoscopic sinus surgery simulation. Am J Rhinol Allergy 27(2):138–143. doi:10.2500/ajra.2013.27.3861
Malekzadeh S, Pfisterer MJ, Wilson B, Na H, Steehler MK (2011) A novel low-cost sinus surgery task trainer. Otolaryngol Head Neck Surg 145(4):530–533. doi:10.1177/0194599811413373 Epub
Accreditation Council for Graduate Medical Education (ACGME) (2011) Common program requirements. http://www.acgme.org/acgmeweb/Portals/0/dh_dutyhoursCommonPR07012007pdf
McGurk M, Amis AA, Potamianos P, Goodger NM (1997) Rapid prototyping techniques for anatomical modelling in medicine. Ann R Coll Surg Engl 79(3):169–174
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 3
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
Waran V, Narayanan V, Karuppiah R, Owen SL, Aziz T (2014) Utility of multimaterial 3D printers in creating models with pathological entities to enhance the training experience of neurosurgeons. J Neurosurg 120(2):489–492. doi:10.3171/2013.11.JNS131066 Epub 2013 Dec 10
Chen G, Ling F (2010) A new plastic model of endoscopic technique training for endonasal transsphenoidal pituitary surgery. Chin Med J (Engl) 123(18):2576–2579
Acar B, Gunbey E, Babademez MA, Karabulut H, Gunbey HP, Karasen RM (2010) Utilization and dissection for endoscopic sinus surgery training in the residency program. J Craniofac Surg 21(6):1715–1718. doi:10.1097/SCS.0b013e3181f3c73b
Wiet GJ, Stredney D, Wan D (2011) Training and simulation in otolaryngology. Otolaryngol Clin North Am 44(6):1333–1350. doi:10.1016/j.otc.2011.08.009 viii–ix
Krisht AF, Yoo K, Arnautovic KI, Al-Mefty O (2005) Cavernous sinus tumor model in the canine: a simulation model for cavernous sinus tumor surgery. Neurosurgery 56(6):1361–1365 discussion 1365–6
Snyderman C, Kassam A, Carrau R, Mintz A, Gardner P, Prevedello DM (2007) Acquisition of surgical skills for endonasal skull base surgery: a training program. Laryngoscope 117(4):699–705
Nogueira JF, Stamm AC, Lyra M, Balieiro FO, Leão FS (2008) Building a real endoscopic sinus and skull-base surgery simulator. Otolaryngol Head Neck Surg 139(5):727–728. doi:10.1016/j.otohns.2008.07.017
Acknowledgments
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
None declared.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Video 1: Demonstration of odontoid drilling in the model (MPG 7596 kb)
Rights and permissions
About this article
Cite this article
Narayanan, V., Narayanan, P., Rajagopalan, R. et al. Endoscopic skull base training using 3D printed models with pre-existing pathology. Eur Arch Otorhinolaryngol 272, 753–757 (2015). https://doi.org/10.1007/s00405-014-3300-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-014-3300-3