A Tablet-based Virtual Environment for Neurosurgery Training

Published in Presence: Teleoperators and Virtual Environments, Spring 2015No. 2, Pages 155-162 Posted Online October 15, 2015. doi:10.1162/PRES_a_00224The requirement for training surgical procedures without exposing the patient to additional risk is well accepted and is part of a national drive in the UK and internationally. Computer-based simulations are important in this context, including neurosurgical resident training. The objective of this study is to evaluate the effectiveness of a custom built virtual environment in assisting training of a ventriculostomy procedure. The training tool (called VCath) has been developed as an app for a tablet platform to provide easy access and availability to trainees. The study was conducted at the first boot camp organized for all year one trainees in neurosurgery in the UK. The attendees were randomly distributed between the VCath training group and the Control group. Efficacy of performing ventriculostomy for both groups was assessed at the beginning and end of the study using a simulated insertion task. Statistically significant changes in performance of selecting the burr hole entry point, the trajectory length and duration metrics for the VCath group, together with a good indicator of improved normalized jerk (representing the speed and smoothness of arm motion), all suggest that there has been a higher level cognitive benefit to using VCath. The app is successful as it is focused on the cognitive task of ventriculostomy, encouraging the trainee to rehearse the entry point and use anatomical landmarks to create a trajectory to the target. In straight-line trajectory procedures such as ventriculostomy, cognitive task based education is a useful adjunct to traditional methods and may reduce the learning curve and ultimately improve patient safety

Comparison of the expressed experiences of survivors of childhood medulloblastoma with measures of health and quality of life, and with issues identified in consultations

When the study was planned, the Young Oncology Unit at The Christie housed both the adult and paediatric follow-up clinics for patients who have been diagnosed with a tumour of the central nervous system (CNS) in childhood and adolescence or young adult life. Over the past 10 years, the paediatric clinic had developed a true multi-disciplinary team function with input from paediatric oncology, clinical oncology, teenage and young adult oncology, neurosurgery, social work, physiotherapy and clinical psychology. In contrast, the adult clinic (for follow-up of patients diagnosed in childhood and also in late teenage or early adult life) had solely medical input. The clinic for the follow-up of adult survivors of childhood CNS tumours at The Christie had significantly less multidisciplinary team involvement than its paediatric counterpart, and it was postulated that adult patients’ needs might not be addressed as fully by the current provision. This study was designed to develop a process to capture information systematically about patients’ problems in the domains of medical, physical, psychological and social wellbeing in order to compare the extent to which these were recognised and supported in the context of the adult and paediatric clinics. Ultimately, this information was expected to inform planning for improvements in survivorship support in both clinics

The Use of Stereoscopy in a Neurosurgery Training Virtual Environment

Published in Presence: Teleoperators and Virtual EnvironmentsWe have previously investigated the effectiveness of a custom built virtual environment in assisting training of a ventriculostomy procedure, which is a commonly performed procedure by a neurosurgeon and a core task for trainee surgeons. The training tool (called VCath) was initially developed as a low fidelity app for a tablet platform to provide easy access and availability to trainees. Subsequently we have developed a high fidelity version of VCath that uses a stereoscopic display to immerse the trainee in the virtual environment. This paper reports on two studies that have been carried out to compare the low and high fidelity versions of VCath, particularly to assess the value of stereoscopy. Study 1 was conducted at the second annual boot camp organized for all year one trainees in neurosurgery in the UK. Study 2 was performed on lay people, with no surgical experience. Our hypothesis was that using stereoscopy in the training task would be beneficial. Results from Study 1 demonstrated that performance improved for both the control group and the group trained with the tablet version of VCath. The group trained on the high fidelity version of VCath with a stereoscopic display showed no performance improvement. The indication is that our hypothesis is false. In Study 2, six different conditions were investigated that covered the use of training with VCath on a tablet, a mono display at two different sizes, a stereo display at two different sizes, and a control group who received no training. Results from this study with lay people show that stereoscopy can make a significant improvement to the accuracy of needle placement. The possible reasons for these results and the apparent contradiction between the two studies are discussed

A feasibility study of enhanced occupational therapy for children and young people with central nervous system tumours – outcomes for the families and for occupational therapy

A two-year feasibility study was conducted to explore harmonisation of occupation-focused practice between two UK children’s cancer centres. The Short Child Occupational Profile (SCOPE) identified occupational needs of children with brain tumours to inform goal-setting, treatment-planning and intervention. A professional decision-making log was developed to focus reflection and to enhance communication of clinical decisions. The impact of a range of personal and environmental factors on participation beyond performance components was considered, enabling the occupational therapists to incorporate the child’s strengths to overcome daily occupational challenges. Twenty-four children aged 3-14 years with central nervous system tumours received enhanced occupational therapy for six months which families perceived as being helpful in rehabilitating children to participate in life and equipping them with better coping strategies for the future. Individual occupational needs of children were highlighted using the SCOPE which helped to standardise practice. Using the SCOPE harmonised occupational therapists’ unique focus on occupation in their practice with patients with brain tumours. This both evidenced intervention outcomes and strengthened professional identity. The outcome was robust preparation for a multi-centre intervention study. Keywords Occupational therapy, children, brain tumour, harmonised practice, SCOP

Identifying the deficiencies of current diagnostic criteria for neurofibromatosis 2 using databases of 2777 individuals with molecular testing

Purpose We have evaluated deficiencies in existing diagnostic criteria for neurofibromatosis 2 (NF2). Methods Two large databases of individuals fulfilling NF2 criteria (n = 1361) and those tested for NF2 variants with criteria short of diagnosis (n = 1416) were interrogated. We assessed the proportions meeting each diagnostic criterion with constitutional or mosaic NF2 variants and the positive predictive value (PPV) with regard to definite diagnosis. Results There was no evidence for usefulness of old criteria “glioma“ or “neurofibroma.” “Ependymoma” had 100% PPV and high levels of confirmed NF2 diagnosis (67.7%). Those with bilateral vestibular schwannoma (VS) alone aged ≥60 years had the lowest confirmation rate (6.6%) and reduced PPV (80%). Siblings as a first-degree relative, without an affected parent, had 0% PPV. All three individuals with unilateral VS and an affected sibling were proven not to have NF2. The biggest overlap was with LZTR1-associated schwannomatosis. In this category, seven individuals with unilateral VS plus ≥2 nondermal schwannomas reduced PPV to 67%. Conclusions The present study confirms important deficiencies in NF2 diagnostic criteria. The term “glioma” should be dropped and replaced by “ependymoma.” Similarly “neurofibroma” should be removed. Dropping “sibling” from first-degree relatives should be considered and testing of LZTR1 should be recommended for unilateral VS