Dear members of the Neurosurgery Hub community,
I am a biomedical engineer, working on a NIH R01 proposal and with a long-standing interest in neurosurgery simulation, emphasizing the skull base. I have a clinical collaborator, but I would like to complement his input with that of other neurosurgeons, to make the proposal, and the simulator if funded, as clinically useful as possible.
I have a background in medical image analysis (including meshing), haptics, neurosurgery navigation, and various other areas of computer-assisted medicine (also collaborating on geriatric fall injury mitigation and breast surgery applications). I did my PhD in neurosurgical brain shift estimation at Montreal Neurological Institute and also had some early patents in neuronavigation. My group has published papers on minimally supervised identification of cranial nerves in T2-weighted MRI
https://pubmed.ncbi.nlm.nih.gov/28422682 https://pubmed.ncbi.nlm.nih.gov/31236805,
and I'm also interested in doing the same with DTI data. I have papers in other related areas: haptics, meshing, etc..
We are emphasizing skull base tumor resection because I believe that this is where there is the most important need, in terms of simulation-assisted improvement of surgical skill, while minimizing risks to patients. I am collaborating with Kitware, which has developed the open-source Interactive Medical Simulation Toolkit (imstk.org). Also working with a haptics company that will customize for surgery low-cost, high-fidelity haptic device with 6/7 degrees-of-freedom. We plan on emphasizing 1 or 2 specific approaches; I'm thinking transsphenoidal/transnasal and pterional, but open to suggestions. Knowing the approach ahead of time means knowing the surgical corridor, and modeling in detail only the anatomy along this corridor, leaving the rest as sparse as possible for an interactive computational response.
So, with those details out of the way, here are some questions...
1) What's hard about neurosurgery where simulation can provide an improvement in surgical performance and in patient outcomes, by ramping up these skills with no risk to the patient?
2) Is there a glaring omission in terms of the approaches that we should start with, vs transphenoidal and pterional?
3) Conversely to 1, what improves over time for a neurosurgeon, which could be accelerated with simulation-based training? (e.g. better force control on instruments, better understanding of neuroanatomy, better identification of intraop pitfalls, better damage control in on-going complications?)
4) What are the complications in skull base surgery that occur where (well-designed) simulation-based training can have an impact? (e.g.: CSF leak, hypophyseal or hypothalamic injuries, blindness/double vision, palsies of CN III, IV, VI, cerebral infarct, carotid artery injuries, meningitis...)
5) Any clinical papers to recommend, especially review papers, that could suggest which complications to key on?
6) Is there something that I should know, to complete the picture, where a neurosurgeon reviewer might say: "What about...?" ?
Thanks for your kind consideration and support. Best wishes,
MichelODU
Michel Audette, Ph.D.
Old Dominion University
I am a biomedical engineer, working on a NIH R01 proposal and with a long-standing interest in neurosurgery simulation, emphasizing the skull base. I have a clinical collaborator, but I would like to complement his input with that of other neurosurgeons, to make the proposal, and the simulator if funded, as clinically useful as possible.
I have a background in medical image analysis (including meshing), haptics, neurosurgery navigation, and various other areas of computer-assisted medicine (also collaborating on geriatric fall injury mitigation and breast surgery applications). I did my PhD in neurosurgical brain shift estimation at Montreal Neurological Institute and also had some early patents in neuronavigation. My group has published papers on minimally supervised identification of cranial nerves in T2-weighted MRI
https://pubmed.ncbi.nlm.nih.gov/28422682 https://pubmed.ncbi.nlm.nih.gov/31236805,
and I'm also interested in doing the same with DTI data. I have papers in other related areas: haptics, meshing, etc..
We are emphasizing skull base tumor resection because I believe that this is where there is the most important need, in terms of simulation-assisted improvement of surgical skill, while minimizing risks to patients. I am collaborating with Kitware, which has developed the open-source Interactive Medical Simulation Toolkit (imstk.org). Also working with a haptics company that will customize for surgery low-cost, high-fidelity haptic device with 6/7 degrees-of-freedom. We plan on emphasizing 1 or 2 specific approaches; I'm thinking transsphenoidal/transnasal and pterional, but open to suggestions. Knowing the approach ahead of time means knowing the surgical corridor, and modeling in detail only the anatomy along this corridor, leaving the rest as sparse as possible for an interactive computational response.
So, with those details out of the way, here are some questions...
1) What's hard about neurosurgery where simulation can provide an improvement in surgical performance and in patient outcomes, by ramping up these skills with no risk to the patient?
2) Is there a glaring omission in terms of the approaches that we should start with, vs transphenoidal and pterional?
3) Conversely to 1, what improves over time for a neurosurgeon, which could be accelerated with simulation-based training? (e.g. better force control on instruments, better understanding of neuroanatomy, better identification of intraop pitfalls, better damage control in on-going complications?)
4) What are the complications in skull base surgery that occur where (well-designed) simulation-based training can have an impact? (e.g.: CSF leak, hypophyseal or hypothalamic injuries, blindness/double vision, palsies of CN III, IV, VI, cerebral infarct, carotid artery injuries, meningitis...)
5) Any clinical papers to recommend, especially review papers, that could suggest which complications to key on?
6) Is there something that I should know, to complete the picture, where a neurosurgeon reviewer might say: "What about...?" ?
Thanks for your kind consideration and support. Best wishes,
MichelODU
Michel Audette, Ph.D.
Old Dominion University
