VIRTUAL NEUROSURGERY

摘要

The craft of surgery is an ancient art. In spite of the past generation's reinvention of our specialty and the monumental refinements in technical procedures in the field, fundamental methods of training and the acquisition of proficiency remain largely archaic—based on approaches that are hundreds of years old. Within the surgeon's three-dimensional space of operations, complex structure and exquisite function provide challenges that now only lengthy periods of training can master. The acquisition of these skills is based on exposure, opportunity and elements of patient risk. Now, the opportunity for a substantive reinvention of a significant component of the training cycle is emerging with the advent of what might be termed virtual neurosurgery—surgical experience within a specifically created virtual reality. These simulated environments with ergonomically acceptable haptic interfaces will reproduce an intimate experience, an experience created by an amalgam of layered recreations of structure, function, pathology, and instrumental interventions (5).FigureFigureFor decades, the military and the aerospace industry have employed simulation for training given the inherent risks to life and equipment during onsite rudimentary learning experiences. For instance, the University of Southern California's Institute for Creative Technologies — an amalgam of expertise from engineering, film, Paramount Studios, and the US Department of Defense — has creative immersive combat situations for infantry. Computer integration now simulates environments that precisely reproduce actual experiences of emergency situations and complex evolutions in military machines, vessels and aircraft. Space missions are experienced by astronauts in training centers, and architects construct, refine, and experience immense projects in virtual environments. It appears that, in the relatively near future, experiences in virtual environments will become part of the neurosurgical landscape—not only for training but for rehearsal of individual surgical challenges and as a basis for telesurgeries with robotic integration.FigureThe concept will be extremely critical and relevant to the evolving trends in minimal invasion and the reduction of need for craniotomy. The occasional vascular surgeries will, in all likelihood, present unusual technical challenges where risk can be reduced by virtual preparation based on constructs of the individual patient's anatomy and pathology (1). The complex neurosurgical haptic interface has presented a significant hurdle, but engineers have suggested that combustion force equations related to rocket fuels and nuclear detonations will solve the issues of touch, pressure, and resistance that are critical to convey absolute required realism (6).FigureThe relatively small volumes characteristic of neurosurgical procedures offer ideal substrates for the computational modeling which is being enhanced daily with advances in microprocessors. It is not beyond the realm of possibility that virtual rehearsal will be a required element of all operative procedures with documentation of feasible approaches essential before a therapeutic event may be undertaken. As a byproduct of this technology, the “new neurosurgeons” will track from engineering backgrounds. As noted by Susan Hockfield, Massachusetts Institute of Technology President and former Yale Provost, in her recent Science editorial, The Next Innovation Revolution, those with engineering backgrounds will play a greater role in not only biological sciences but also their clinical counterparts (2,3).FigureThis month both NEUROSURGERY and OperativeNEUROSURGERY feature manuscripts relevant to these concepts and offer suggestions for the new emerging facets of our rapidly evolving “technology driven” specialty (2,4). Michael L.J. Apuzzo Los Angeles, California