JP4448153B2 - Neurosurgical training device, brain model used in this device, and model subject - Google Patents

Description

  We have provided a training device that allows you to experience neurosurgery procedures and master them, so that you can learn how to operate them, perform image processing, and verify and evaluate them. It is also intended to provide the brain model and model subject used for this.

  Neurosurgery requires the use of cerebral spars, bipolars, suction tubes, micro-scissors and surgical microscope operation, and it is safe and accurate for the surgeon to be proficient in using these tools. Essential to do quickly. However, it is only vascular anastomosis practice using rats that is currently established that can be practiced under such a microscope.

  The inventors of the present invention are to provide a training apparatus, a brain model, and a model subject that can perform training similar to the practice of neurosurgery in neurosurgery.

  Education and training for acquiring techniques in conventional surgical operations include surgical tours, surgical assistants, practice under supervising doctors, learning with books and electronic media (video / DVD), vascular anastomosis exercises in rats Etc. is the main.

  As a conventional training system under a microscope, there is a surgical practice method using a cadaveric brain and skull for dissection. It is possible to practice or consider skull base surgery, and to understand the surgical anatomy of the brain. However, the elasticity of living brain tissue cannot be reproduced, repeated practice is not possible, and specimens are difficult to obtain in Japan. There are some difficulties.

In addition, in the case of surgical practice by virtual simulation using a computer, it is possible to practice repeatedly regardless of time and place, and there is an advantage that a surgical microscope is not necessary, but it reproduces the visual and tactile sense in actual surgery There are many difficult points to do.
Japanese National Patent Publication No. 10-512854 JP 2002-14610 A JP 2003-241647 A JP 2004-303220 A

  In the conventional practice method, it is often impossible to repeatedly practice, and it is difficult to grasp the actual feeling at the operation site. Also, in practice that relied on images, it was difficult to acquire actual techniques. Especially for neurosurgery, there is no device that can acquire brain tissue and elasticity, and you can feel the use of tools essential for surgery such as brain spatula, bipolar, suction tube, micro scissors and operation microscope operation. In addition, there was no practice device and no verification and evaluation methods.

  Furthermore, there has conventionally been no brain model that can acquire the elasticity and elasticity of the brain that is indispensable for neurosurgical training.

In order to solve the above-mentioned problems, the present invention first comprises three parts of frontal lobe, temporal lobe, and brain stem by silicone, urethane, styrene and other elastomers that can maintain the shape and are elastic and reproduce the human brain. A model was formed and these three models were merged, a blood vessel model was added, and the model was loaded into a skull model with an open head, and the bottom surface of the skull model was closed with a cushioning material to provide the model main body.

In order to reproduce the movement of the brain at the time of surgery, the brain model was blocked with a buffer material so that the brain model moved appropriately within the skull model when it was pressed with a cerebrum.
The training apparatus is characterized by providing a base on which the model main body can be placed with an appropriate inclination angle.

The model body is placed on the base at an appropriate inclination so that it feels like the skull of a person lying on the operating table and the brain tissue and elasticity can be acquired through the head. is there.

  In addition, focus on the brain model using a surgical microscope, master the microscope operation, perform image processing and perform operations such as brain spatula, bipolar, suction tube, micro scissors, etc. and experience this It was possible to practice such as verifying and evaluating and developing improvement measures.

  In addition, by using this neurosurgical training device, it is possible to perform repetitive practice, and the order and change of procedures, and evaluation by a supervising physician are possible.

  In addition, the brain model and the model body for constructing such a training device are made of silicone, urethane, styrene and other elastomers that can maintain the shape and are elastic enough to reproduce the human brain. I was able to.

  Detailed configuration is shown below.

In the first aspect of the present invention, a skull model having an open head on the upper surface and a bottom surface opened on the lower surface, and a three-model model of the frontal lobe, the temporal lobe, and the brain stem are combined in the skull model. silicone, urethane, rich in styrene and other shapes sustainable elastic, provided with elastomeric brain model simulates a biological human brain, a cushioning material for closing the bottom of the skull model, a model entity consisting of the cushioning material Has two surfaces that are in contact with each other at an appropriate inclination angle at a straight portion, and a base having two flat portions, a horizontal surface and an inclined surface, is provided, and two surfaces of the model-based cushioning material are two of the base. The neurosurgical training apparatus was combined so that the model main body was placed on the base in an inclined manner so as to match the two flat portions .

  According to the second aspect of the present invention, it is possible to perform clipping practice using an aneurysm model by using a brain model provided with an arterial blood vessel and a venous blood vessel or an aneurysm model arranged in the vicinity of the Sylvian fissure.

According to a third aspect of the present invention, the craniotomy is performed through the craniotomy by opening the craniotomy provided on the skull model in the vicinity of the Sylvian fissure where the frontal lobe and the temporal lobe of the built-in brain model face each other. You can now learn the basic operations and techniques.

The fourth aspect of the present invention is that when the head of the skull model is opened at a position deviated from the center position of the skull model , and the model main body is turned 180 degrees on the base, the inclination of the skull model changes, and the head opening The angle of inclination changed so that the operative field could be changed.

According to a fifth aspect of the present invention, two surfaces are provided on the bottom surface of the cushioning material that contact each other at an angle of about 30 degrees with the straight line as a boundary, and the horizontal surface of the base and the inclined surface that coincide with these two surfaces are in contact with each other at an inclination of about 30 degrees. I made it.

According to the sixth aspect of the present invention, the cushioning material that closes the bottom surface of the skull model forms a gap with the brain model, thereby realizing an elastic state that is extremely close to that of a living human brain.

Seventh invention, rich a model for the 3 frontal portion and the side lobe portion and brainstem silicone, urethane, styrene and other shapes Sustainable and resilient, molded by elastomer which reproduces the living human brain, respectively The brain model was cut and merged to provide a brain model. The frontal lobe, temporal lobe, and brainstem model can be easily assembled by cutting, and can be stably loaded into the skull model.

In the eighth aspect of the present invention, a skull model having an open head on the upper surface and a bottom surface opened on the lower surface, and a three-part model of the frontal lobe, the temporal lobe, and the brain stem are combined in the skull model . A model body consisting of silicone, urethane, styrene, etc., which has a shape that can maintain its shape, is elastic, and reproduces a living human brain, and a cushioning material that blocks the bottom of the skull model with this brain model. Provided . Two surfaces that are in contact with the bottom surface of the cushioning material at an appropriate inclination angle with respect to the straight portion are provided .

  The frontal lobe, temporal lobe, and brainstem model are made of silicone, urethane, styrene and other elastic materials that can maintain their shape and are made of elastomer that reproduces the human brain. You can experience the condition. In addition, the three parts of the frontal lobe, the temporal lobe, and the brain stem are each wrapped with a plastic thin film, so that an operation of cutting the arachnoid membrane with micro scissors can be obtained.

By selecting the vicinity of the Sylvian fissure as the head of the skull model, the basic operation and procedure of microscopic surgery can be learned. In addition, by loading a brain model into the skull model, the situation closer to the actual operation can be obtained using the open head.

  In the present invention, it is possible to apply the practice of the technique of opening the Sylvian cleft from the right frontotemporal craniotomy, which can be said to be the basic of neurosurgery, the vascular anastomosis practice using an artificial blood vessel, and the clipping practice using an aneurysm model. By using a motion analysis device, it is possible to verify and evaluate the operation of the procedure. Therefore, the device of the present invention is effective as a new training method for neurosurgical microscopy.

In the present invention, a skull model having an open head on the upper surface and a bottom surface opened on the lower surface, and a silicone and urethane which are combined with the three-part model of the frontal lobe, the temporal lobe, and the brain stem, which are built in the skull model A model body composed of an elastomeric brain model that can maintain a shape, such as styrene, is elastic and reproduces a living human brain, and a buffer material that closes the bottom surface of the skull model. A neurosurgical training device provided with a foundation to be placed with an inclination angle was provided.

Two surfaces that are in contact with the straight part at an appropriate inclination angle are provided on the bottom surface of the cushioning material mainly composed of the model , and a base having a horizontal surface and an inclined surface that match the two surfaces is combined.

  The configuration will be described below with reference to the drawings shown as examples.

In FIG. 1, 1 is a skull model, showing a state inclined about 30 degrees as viewed from the back side. 2 indicates an open head. 3 is a frontal lobe model, and 4 is a temporal lobe model. 5 is a model subject.
Reference numeral 6 denotes a base, which has two flat portions that contact each other at an angle of about 30 degrees with the straight portion 6a as a boundary.

FIG. 2 is a side view of the skull model, which has an open head on the upper surface and a bottom surface opened on the lower surface . The open head 2 was provided on the right frontal side .

FIG. 3 shows a brain model divided into three parts, and each bottom part is cut and merged so as to be loaded into the skull model and processed stably. 3 is a frontal lobe model, 4 is a temporal lobe model, and 7 is a brainstem model, which is made of silicone, urethane, styrene, or other elastomer that can maintain its shape, is elastic, and reproduces a living human brain. In particular, by being composed of silicone, the elasticity and shape that are very close to those of living human-type brain tissue are maintained, and the structure is suitable for practicing microscopic surgery.

  8 is an arterial blood vessel model, and 8a is an aneurysm model. 9 is a venous blood vessel model. The blood vessel model is made of plastic, bent into an appropriate shape, and wrapped with a plastic arachnoid wrap. I put them in a lump and wrap them with arachnoid wrap.

  The arterial blood vessel used in the vicinity of the Sylvian fissure can be a model of an arterial blood vessel for anastomosis or a blood vessel for graft (transplant).

FIG. 4 is an explanatory diagram of a state in which three divided brain models are combined. FIG. 5 shows a brain model 10 in which the frontal lobe model and the temporal lobe model face each other with the Sylvian fissure 11 as a boundary.
Reference numeral 12 denotes a cut portion.

  Although not shown, the frontal lobe model 3, the temporal lobe model 4 and the brainstem model 7 are each wrapped in a thin film made of synthetic resin, and further, the brain model 10 and the brain model 10 are wrapped together. Because it is, you can experience the properties of the spider membrane.

FIG. 6 shows the model main body 5 as seen from the back side, and a cushioning material 13 for closing the bottom surface of the skull model is provided. The buffer material 13 is made of an elastic plastic. The cushioning material was bisected from the center to enhance elasticity. In addition, an air gap 16 is formed between the brain model and an elastic state that is very close to that of a living human brain. In addition, the buffer material 13 may be an integral object.

  The cushioning material 13 is provided on the back of the brain model 10 built in the skull model 1 to assist the elasticity in addition to the elasticity of the material possessed by the brain model, and the movement of the brain when pressed with a balun. It can be reproduced. In addition, the brain model 10 is built in the skull, and the back surface is closed and stabilized by the cushioning material 13, and the brain model 10 is easily placed on the base 6.

  7 and 8 show the relationship between the base 6 and the model main body 5. In FIG. 7, the model main body 5 shows an inclination of 30 degrees on the base, and in FIG. 8 the base by changing the orientation of the model main body 5 by 180 degrees. 6 shows a state inclined at 60 degrees on 6. By changing the tilted state in this way, it is possible to perform training with changes in the posture of the doctor, setting of various tools, and other operations during the operation under the microscope.

  FIG. 9 is an explanatory diagram of a state in which the brain spatula 14 and the micro scissors 15 are used for the brain model. It became possible to practice not only the opening of the Sylvian fissure but also the clipping of the aneurysm provided in the deep arterial vascular model.

  It is also possible to create a venous blood vessel model 9 as a sylvian bain (brain surface vein) as a target at the time of Sylvian cleft incision.

A suction tube for sucking cerebrospinal fluid and blood in the brain can be attached.
An example of a microscope training test procedure is given below. This is an example of a procedure using the model subject of the present invention, and is not limited to this example .

(1) Operate the surgical microscope to focus on the brain surface of the incised part of the brain model
(2) Placing a brain spatula on an appropriate site
(3) Fix the suction tube and apply tension
(4) Cut the brain surface membrane with micro scissors
(5) Peel off the Sylvian fissure with micro scissors and bipolar (peeling and sharp dissection)

(6) Multiply the brain spatula by Silvius
(7) Check the surface of M2 and peel off the surroundings
(8) Hang the brain spatula proximally
(9) Furthermore, the Sylvian fissure is peeled off with micro scissors and bipolar, and the MCA is traced (peeling and sharp dissection).
(10) Hang the brain spatula proximally

(11) Check A1 and M1 and peel around
(12) Hang the brain spatula proximally.
(13) Keep the proximal part of the ICA in the field of view, peel off the surroundings, and focus on the ICA surface (end point)
(14) Multiply brain spatula to A1 branch point
(15) Follow A1 to INTERHEMHERIC FISSURE.

  In microsurgery. There are features in how to use the tool and the movement of the hand, and there is an effect that the technique can be acquired quickly by proceeding with exercise training and analysis using the model.

The following are examples of items related to such a technique and for checking this.
Microscope operations include pin alignment, foot switch, magnification, viewpoint direction, visual field center position determination, bipolar, micro scissors, suction tube usage, hand fixation and tool stability, shallow and deep operation, insertion Verify direction, interlocking of both hands, etc.

  The graph of FIG. 10 is an example of an evaluation on the progress state of a procedure image-processed through a microscope. It shows ABC's evaluation for each of microscope, brain spatula, suction tube, bipolar, and micro scissors, which can be used for self-judgment, acquisition of medical technology, and analysis as a supervisor I can understand the teaching points.

An example of an evaluation item table for surgical training under a microscope is shown below.
Focusing:
The magnification can be changed smoothly.
The focus can be adjusted smoothly using the switch.
How to use Brain Vera:
You can put the brain spatula from the right direction at the right position.
The position of the brain spatula can be moved smoothly.
Brain tension is appropriate.
How to use the suction tube:
The suction tube can be fixed in an appropriate position.
Can properly tension the brain.
Can be moved in conjunction with bipolar and scissors.

How to use bipolar:
Bipolar can be fixed in an appropriate position.
Open and close the bipolar properly to avoid injury.
It can be inserted from an appropriate direction and moved smoothly.
How to use micro scissors:
Micro scissors can be fixed.
Can be inserted and incised from an appropriate direction.
A smooth incision can be made.

  Because it is a training device that matches the social situation that places great importance on experience and achievements as neurosurgery, it greatly contributes to surgical practice experience of young doctors.

  Completion of the brain model allows you to experience the elasticity of brain tissue and contributes to repeated practice, contributing to the development of medical technology, information transmission, and the increase in neurosurgeons.

  It is easy to manufacture skull model and brain model, model main body, arterial blood vessel model, venous blood vessel model, aneurysm, etc., contributes to industrial development as medical equipment, and is useful for the advancement of medical technology as training equipment. .

The perspective view of the training apparatus of this invention neurosurgery. Skull model. An exploded view of the brain model. The merged explanatory diagram of the brain model. The top view of a brain model. The back surface explanatory drawing of a model main body. Cross-sectional explanatory drawing in which the model main body is inclined by 30 degrees on the base. Cross-sectional explanatory drawing in which the model main body is inclined 60 degrees on the base. Illustration of Sylvian fissure surgery practice. Explanatory drawing of the example of evaluation of a technique.

DESCRIPTION OF SYMBOLS 1 Skull model 2 Open head 3 Frontal lobe model 4 Temporal lobe model 5 Model main body 6 Base 7 Brain stem model 8 Arterial blood vessel model 9 Venous blood vessel model 10 Brain model 11 Silvius fissure 12 Cut part 13 Buffer 14 Brain vera 15 Micro Scissors
16 gap

Claims (8)

A skull model having an open head on the upper surface and a bottom surface opened on the lower surface;
An elastomeric brain that is built into this skull model, and that has a three-part model consisting of the frontal lobe, temporal lobe, and brainstem. Model and
A cushioning material for closing the bottom surface of the skull model, and a model main body comprising :
The bottom surface of the cushioning material has two surfaces that are in contact with each other at an appropriate inclination angle at a linear portion, and a base having two plane portions, a horizontal surface and an inclined surface, which coincide with the two surfaces, is provided.
A neurosurgical training apparatus comprising a combination of the model main body so that two surfaces of the buffer material of the model main body coincide with two flat portions of the base and the model main body is inclined and placed on the base . The neurosurgical training apparatus according to claim 1, wherein a model of an arterial blood vessel and a venous blood vessel or an aneurysm arranged near the Sylvian fissure is attached as a brain model . The training apparatus for neurosurgical surgery according to claim 1 , wherein the craniotomy provided in the skull model is opened in the vicinity of the Sylvian fissure where the frontal lobe and the temporal lobe of the interior brain model face each other . Variation craniotomy provided skull model is opened in a position offset from the center of the skull model, the model entity by 180 degrees turning on the soil base, the operative field by changing the inclination angle of the model entities The neurosurgical training apparatus according to claim 1, wherein the training apparatus is capable of being used. On the bottom surface of the cushioning material that closes the bottom surface of the skull model, there are provided two surfaces that contact each other at an angle of about 30 degrees with the straight line as the boundary, and the horizontal surface of the base that matches these two surfaces and the inclined surface contact with each other at an inclination of about 30 degrees The neurosurgical training apparatus according to claim 1, which is configured as described above . 2. The neurosurgical training apparatus according to claim 1, wherein the cushioning material for closing the bottom surface of the skull model forms a gap between the cushion model and the built-in brain model . Three parts of the frontal lobe, temporal lobe, and brain stem are modeled with silicone, urethane, styrene, and other elastomers that maintain shape and are elastic enough to reproduce the human brain , and each bottom is cut. The merged brain model. A skull model having an open head on the upper surface and a bottom surface opened on the lower surface ;
An elastomeric brain that is built into this skull model, and that has a three-part model consisting of the frontal lobe, temporal lobe, and brainstem. The model main body which consists of a model and the shock absorbing material which has two surfaces which contact | connect a linear part with a suitable inclination angle in a bottom face, and obstruct | occludes the bottom face of a skull model.

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