title: Frameless image-guided neuroendoscopy training in real simulators.
abstract: BACKGROUND
  Over the last decade, neuroendoscopy has re-emerged as an interesting option in the management of intraventricular lesions in both children and adults. Nonetheless, as it has become more difficult to use cadaveric specimens in training, the development of alternative methods was vital. The aim of this study was to analyze the performance of a real simulator, in association with image-guided navigation, as a teaching tool for the training of intraventricular endoscopic procedures.
  
  
  METHODS
  3 real simulators were built using a special type of resin. 1 was designed to represent the abnormally enlarged ventricles, making it possible for a third ventriculostomy to be performed. The remaining 2 were designed to simulate a person's skull and brain bearing intraventricular lesions, which were placed as follows: in the foramen of Monro region, in the frontal and occipital horns of the lateral ventricles and within the third ventricle. In all models, MRI images were obtained for navigation guidance. Within the ventricles, the relevant anatomic structures and the lesions were identified through the endoscope and compared with the position given by the navigation device. The next step consisted of manipulating the lesions, using standard endoscopic techniques.
  
  
  RESULTS
  We observed that the models were MRI compatible, easy and safe to handle. They nicely reproduced the intraventricular anatomy and brain consistence, as well as simulated intraventricular lesions. The image-based navigation was efficient in guiding the surgeon through the endoscopic procedure, allowing the selection of the best approach as well as defining the relevant surgical landmarks for each ventricular compartment. Nonetheless, as expected, navigation inaccuracies occurred. After the training sessions the surgeons felt they had gained valued experience by dealing with intraventricular lesions employing endoscopic techniques.
  
  
  CONCLUSIONS
  The use of real simulators in association with image-guided navigation proved to be an effective tool in training for neuroendoscopy.
authors.affiliation: Department of Neurosurgery , Neurologia Institute of Curitiba , Curitiba PR , Brazil. g igicoelho7@hotmail.com
authors.forename: G
authors.initials: G
authors.lastname: Coelho
authors.forename: C
authors.initials: C
authors.lastname: Kondageski
authors.forename: F
authors.initials: F
authors.lastname: Vaz-Guimarães Filho
authors.forename: R
authors.initials: R
authors.lastname: Ramina
authors.forename: S C
authors.initials: SC
authors.lastname: Hunhevicz
authors.forename: F
authors.initials: F
authors.lastname: Daga
authors.forename: M R
authors.initials: MR
authors.lastname: Lyra
authors.forename: S
authors.initials: S
authors.lastname: Cavalheiro
authors.forename: S T
authors.initials: ST
authors.lastname: Zymberg
mesh_terms: D003188:Composite Resins / Q000592:standards; D003399:Craniotomy / Q000193:education / Q000295:instrumentation; D004503:Education, Medical, Graduate / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008953:Models, Anatomic; D044583:Neuroendoscopy / Q000193:education* / Q000295:instrumentation; D038361:Neuronavigation / Q000193:education* / Q000295:instrumentation; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted / Q000193:education* / Q000295:instrumentation; D013663:Teaching / Q000379:methods*; D014696:Ventriculostomy / Q000193:education / Q000295:instrumentation
chemical_list: D003188:Composite Resins