RU2788839C2 - Neurosurgical simulator - Google Patents

Abstract

FIELD: neurosurgery, namely devices for the development of neurosurgical skills.

SUBSTANCE: The neurosurgical simulator comprises a body imitating the bones of the skull, at least one outer layer of elastic material imitating extracranial soft tissues, and at least one inner layer of elastic material imitating the dura mater, and an internal element imitating the brain placed in the body, characterized in that the body has the shape of a hollow polyhedron, contains at least one removable working plate for practicing the skills of working with the bones of the skull, including trefination, bone-plastic and resection trepanation, as well as fixation of the bone flap and cranioplasty, and elements for fixing the outer and inner layers to the body and maintaining them in a stretched state, while the outer and inner layers are made of sheet polymer, and the working plate and the inner and outer layers are placed with the possibility of replacement.

EFFECT: The present invention enables to simulate bones of the skull for practicing.

9 cl, 5 dwg

Description

The technical field to which the invention belongs

The invention relates to neurosurgery, namely to simulators for the development of neurosurgical skills.

State of the art

Novice neurosurgeons need to be able to perform various surgical approaches and properly close the wound upon completion of the main stage of the operation. This implies mastering the technique of working with each layer of tissues covering the nervous system, in particular, the brain: meninges (cutting, suturing, plastic), skull bones (drilling, milling, sawing, biting, grinding, suturing, plastic) , extracranial soft tissues (incisions, suturing, plastic surgery). Various training devices are used to develop these skills without causing harm to living patients.

Known simulator, including an external element that simulates the skull, an intermediate element that simulates the dura mater, and an internal element that simulates the brain [1].

This device has the following limitations:

1) Complex shape, causing the complexity and high cost of manufacturing;

2) The implementation of the external element in the form of a single body, gradually destroyed during training, which reduces its shelf life;

3) The absence of a layer that mimics extracranial soft tissues.

Known simulator, including simulating the morphological structures of the brain, dura mater, cranial vault and skin, while the cranial vault is made of protacryl, the brain is made of paraffin, covered with polyethylene film, and the dura and skin are made of cotton fabric impregnated with silicone [ 2].

The disadvantages of this device are the complexity of the form and the complexity of manufacturing.

Disclosure of invention

The technical result of the proposed invention is to simplify the design and increase the interchangeability of parts of the simulator, as well as expand its functionality.

To achieve this technical result, a simulator has been developed that contains a body that imitates the bones of the skull, at least one outer layer of elastic material that imitates extracranial soft tissues, and at least one inner layer of elastic material that imitates the dura mater, and an internal element placed in the body , simulating the brain, characterized in that the body has the shape of a hollow polyhedron, contains at least one removable work plate for practicing skills in working with the bones of the skull, including trephination, osteoplastic and resection trepanation, as well as fixation of the bone flap and cranioplasty, and elements for fixing the outer and inner layers to the body and maintaining them in a taut state, while the outer and inner layers are made of sheet polymer, and the working plate and the inner and outer layers are placed with the possibility of replacement.

The housing can be made in the form of a box with a sliding lid.

The body may contain clips, staples, binding bolts, an adhesive coating or Velcro tape to secure the outer and inner layers.

The lid may contain a pre-made trepanation window and an insertion flap of an appropriate shape, while holes for suturing can be drilled along the perimeter of the window, as well as along the perimeter and in the center of the flap.

The lid may contain markings indicating the location of the burr holes, burr window, and suturing holes.

The bottom and/or walls of the housing may contain at least one layer of cork, designed to fix training objects with pushpins, paper clips and rubber bands.

The bottom and/or walls of the housing may contain protrusions and/or recesses for storing neurosurgical instruments, consumables, and removable parts of the simulator.

The bottom and/or walls of the case can be made with the possibility of fixing the simulator to the desktop or the walls of the training room using fasteners, for example, self-tapping screws.

The internal element imitating the brain can be made in the form of an inflatable balloon, for example, a balloon or a glove.

The body can be made of wood or plastic; the working plate can be made of wood, plastic or colorless plexiglass; the inner layer can be made of microfiber, tarpaulin or cotton; and the outer layer can be made of silicone, polyvinyl chloride, ethylene vinyl acetate or thermoplastic elastomer.

The implementation of the body in the form of a hollow polyhedron and the working module in the form of a removable plate, as well as the implementation of the outer and inner layers of sheet polymer, makes it possible to simplify and reduce the cost of manufacturing the simulator as much as possible, while each of its parts is interchangeable, which significantly increases its service life.

The presence of a system of fixing elements makes it easy to install and replace the outer and inner layers, maintaining them in the required degree of tension. In addition, it becomes possible to easily change their number depending on the simulated clinical situation.

The presence of an internal element made in the form of an inflatable balloon allows the surgeon to receive feedback on his actions in case of violation of the integrity of the internal element.

It is important to note that the hollow body has walls and a bottom, which makes it possible to additionally place cork sheets on their inner surface, which makes it possible to fix training objects, for example, isolated vessels or nerves, and practice microsurgical or endoscopic techniques on them using a trepanation window in the simulator cover as a limiter of the operating field. In addition, surgical instruments, consumables and removable parts of the simulator can be stored in the body cavity.

Description of drawings

In FIG. 1 shows the body and working plate of the proposed simulator in a particular case of its manufacture. An inset flap has been sawn into the plate.

In FIG. 2 shows a set of parts included in the simulator, with the exception of clamps for fixing the outer layer (not visible from this angle).

In FIG. 3 shows a partially assembled machine with an additional inner member, inner layer and work plate installed. The inner layer has been opened.

In FIG. 4 shows the working area of the simulator before performing the exercise for suturing the dura mater. Task: to sew up the cut of the inner layer without damaging the inner element.

In FIG. 5 shows a fully assembled simulator. One of the clamps for fixing the outer layer is visible.

In FIG. 1-5 numbers indicate:

1 - Body

2 - Working plate

3 - Trepanation window

4 - Flap

5 - Clamps for fixing the inner layer

6 - Inner layer

7 - Clips for fixing the outer layer

8 - Outer layer

Implementation of the invention

The neurosurgical simulator comprises a body imitating the bones of the skull, at least one outer layer of elastic material imitating extracranial soft tissues, and at least one inner layer of elastic material imitating the dura mater, and an internal element placed in the body imitating the brain, and differs in that the body has the shape of a hollow polyhedron, contains at least one removable working plate for practicing skills in working with the bones of the skull, including trephination, osteoplastic and resection trepanation, as well as fixation of the bone flap and cranioplasty, and elements for fixing the outer and inner layers to the body and keeping them in a taut state, while the outer and inner layers are made of sheet polymer, and the working plate and the inner and outer layers are placed with the possibility of replacement.

In a specific embodiment (Fig. 1-5), the body of the simulator (1) is a wooden box with a retractable lid (2), while the lid contains clips (5) for fixing the inner layer (6), and the body contains clips (7 ) to fix the outer layer (8). The cover in this example contains a pre-made trepanation window (3) and a free insertion flap (4) of a corresponding shape, while a lot of holes for suturing are drilled along the perimeter of the window, as well as along the perimeter and in the center of the flap. The internal element (9), imitating the brain, is represented by a balloon.

The proposed device is used as follows.

The simulator is prepared for work: the inner layer is fixed to the working plate, then the plate is installed in the body and the outer layer is fixed to it.

Fixation is possible with elements such as clips, staples, binding bolts, adhesive coating (double-sided tape) or Velcro tape. In this case, several layers can be fixed at once, imitating the layered anatomy of the extracranial soft tissues (aponeurotic skin and muscle layers, periosteum, etc.), as well as the dura mater (outer and inner sheets).

Next, an incision is made in the outer layer with a scalpel. The edges of the incision are bred to the sides with a retractor or with the help of sutures, holders, elastic bands, etc.

In the event that an intact working plate was installed, one or more typical interventions are performed on it, depending on the simulated situation:

1. Trefination: imposition of a burr hole with a brace, perforator or craniotomy with a spherical nozzle;

2. Osteoplastic trepanation (option A): the imposition of several burr holes (minimum 4) using a brace and making cuts between them with a wire saw;

3. Osteoplastic trepanation (option B): imposition of several burr holes (at least one) using a perforator or craniotome with a spherical nozzle and cutting out a trepanation window using a craniotome with a sawing nozzle through these burr holes;

4. Resection trepanation: imposition of a burr hole with the help of a brace and biting through the trepanation window through this hole with the help of neurosurgical nippers.

Along the edge of the trepanation window and at the corresponding points of the edge of the flap, a number of peripheral holes with a diameter of up to 2 mm (peripheral holes) are drilled with a narrow drill. Two holes are also drilled in the center of the flap (center holes).

Finally, an incision is made in the inner layer using a scalpel and surgical scissors.

The "wound" is closed in reverse order, restoring the integrity of each layer with the help of appropriate surgical sutures according to the situation.

First, an imitation of the dura mater is sutured. At this stage, it is possible to simulate duroplasty by sewing into the shell defect a patch made of tissue similar in composition to the inner layer of the simulator.

Next, the flap is fixed to the trepanation window using single sutures, craniofixes, or titanium plates. Also at this stage, it is possible to simulate cranioplasty by closing the trepanation window with a patch made of another material: titanium mesh, bone cement, etc. In all cases, before installing the flap, the simulated dura mater must be fixed with ligatures to the edges of the trepanation window through pre-drilled peripheral holes, as well as to the center of the flap through the central holes (simulation of cranio-dural sutures-holders).

Finally, the outer layer is sutured. At this stage, it is possible to develop the skills of skin plastic surgery.

After the session, the removable plate with the already performed trepanation defect, as well as the cut outer and inner layers, can be reused, focusing on the wound closure technique, or exchanged for new ones.

To complicate the task, you can install an internal element imitating the brain into the body, while during all manipulations it is necessary to clearly control your actions in order to avoid damaging it; negative feedback manifests itself as depressurization of the inflatable balloon (the balloon bursts).

In the event that the bottom or walls of the body contain cork sheets, the proposed simulator can be used for practicing microsurgical and/or endoscopic techniques. To do this, when assembling the simulator, instead of installing an internal element, a training object (isolated vessel, nerve, etc.) is attached to these sheets using push pins, paper clips, rubber bands, etc. A trepanation of the required size is performed in a removable plate, after which the necessary skills (dissection, anastomoses, etc.) are practiced through the formed window, which recreates work in a deep and narrow surgical field.

Surgical instruments, consumables, clamps, outer and inner layers, as well as the inner element can be stored inside the case between workouts.

List of used literature

1. Virkelyust T.K. Ask O.K., Matula K., De Eva A. Head layout for medical training of surgeons and method. Patent EA 023877 B1. The application date is 03.04.2012. Date of publication and grant of the patent 29.07.2016.

2. E. M. Trunin, I. G. Zakhmatov, A. A. Smirnov, V. V. Tatarkin, A. I. Nazmiev, D. V. Yakovenko, E. V. Yakovlev, and Sh. Rybakov V.A. A simulator for mastering manual surgical skills on the cerebral region of the head in a real topographic anatomical environment. Patent RU 172037 U1. Application date is 12/29/2016. Date of publication and grant of the patent 06/26/2017.

Claims (10)

1. A neurosurgical simulator containing a body that imitates the bones of the skull, at least one outer layer of elastic material that imitates extracranial soft tissues, and at least one inner layer of elastic material that imitates the dura mater, and placed in the body an internal element that imitates the head the brain, characterized in that the body has the shape of a hollow polyhedron, contains at least one removable working plate for practicing skills in working with the bones of the skull, including trephination, osteoplastic and resection trepanation, as well as fixation of the bone flap and cranioplasty, and elements for fixation outer and inner layers to the body and keeping them in a taut state, while the outer and inner layers are made of sheet polymer, and the working plate and the inner and outer layers are placed with the possibility of replacement. 2. Neurosurgical simulator according to claim 1, characterized in that the case is made in the form of a wooden or plastic box with a sliding lid. 3. The neurosurgical simulator according to claim 2, characterized in that the body contains clamps, staples, binding bolts, an adhesive coating or Velcro tape for fixing the outer and inner layers to the body. 4. The neurosurgical simulator according to claim 2, characterized in that the lid contains a trepanation window and an insert flap of an appropriate shape, while holes for suturing are drilled along the perimeter of the window, as well as along the perimeter and in the center of the flap. 5. The neurosurgical simulator according to claim 2, characterized in that the lid contains markings indicating the location of the burr holes, the burr window, and the holes for suturing. 6. The neurosurgical simulator according to claim 1, characterized in that the bottom and/or walls of the body contain a layer of cork designed to fix training objects with push pins, paper clips and rubber bands. 7. Neurosurgical simulator according to claim 1, characterized in that the bottom and/or walls of the body contain protrusions and/or recesses for storing neurosurgical instruments, consumables and removable parts of the simulator. 8. Neurosurgical simulator according to claim 1, characterized in that the bottom and/or walls of the body are made with the possibility of fixing the simulator to the desktop or walls of the training room using fasteners, such as self-tapping screws. 9. The neurosurgical simulator according to claim 1, characterized in that the internal element simulating the brain is made in the form of an inflatable balloon, such as a balloon or a glove. 10. Neurosurgical simulator according to claim. 1, characterized in that the body is made of wood or plastic; the working plate is made of wood, plastic or colorless plexiglass; the inner layer is made of microfiber, tarpaulin or cotton; and the outer layer is made of silicone, polyvinyl chloride, ethylene vinyl acetate or thermoplastic elastomer.

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