ハプティクスを活用した実体感型脳神経外科手術シミュレーション

Interactive Virtual Simulation with Haptics for Neurosurgery

Point

・医療画像から作成する3次元融合画像データを使用した3次元実体感型シミュレーションシステム法の実際を紹介する．

・頭蓋底部腫瘍などを中心に，① 標準的な開頭・骨削除方法や病変への到達法に関する術前シミュレーションとしての活用，② 大きな深部腫瘍の摘出手順を理解するための工夫，③ アプローチの悩ましい症例における検討，など多岐にわたる活用法がある．

・手術シミュレーションだけではなく，解剖実習などに活用することで学習の機会をより効果的にするためのツールにもなり得る．

　We established a unique pre-surgical simulation method by applying interactive virtual simulation（IVS）using multi-fusion three-dimensional imaging data, presenting high-quality visualization of microsurgical anatomies. Our IVS provided a realistic environment for imitating surgical manipulations, such as dissecting bones, retracting brain tissues, and removing tumors, with tactile and kinesthetic sensations delivered through a specific haptic device. The great advantage of our IVS was in deciding the most appropriate craniotomy and bone resection to create the optimal surgical window and obtain the best working space with a thorough understanding of the lesion-bone relationship. Particularly for skull-base tumors, tailoring the procedures to individual patients for craniotomy and bone resection was sufficiently achieved using our IVS. In cases of large skull base meningiomas, our IVS was also helpful preoperatively regarding tumors, as several compartments were achievable in every potentially usable surgical direction. Additionally, the non-risky realistic microsurgical environments of the IVS provided improvement in the microsurgical senses and skills of young trainees through the repetition of surgical tasks. Finally, our presurgical IVS simulation method provided a realistic environment for practicing microsurgical procedures virtually and enabled us to ascertain the complex microsurgical anatomy, determine optimal surgical strategies, and efficiently educate neurosurgical trainees.