Development of a Simulation Model for Fluorescence-Guided Brain Tumor Surgery

Area of Science:

• Neurosurgery
• Medical Simulation
• Surgical Oncology

Background:

• Fluorescence dyes are increasingly vital in neurosurgery for guiding tumor resections.
• Developing effective simulation models is crucial for training neurosurgery trainees in fluorescence-guided surgery.
• High-grade glioma (HGG) surgery presents unique challenges requiring specialized training tools.

Purpose of the Study:

• To create a realistic tumor model for fluorescence-guided surgery simulation in high-grade glioma (HGG).
• To evaluate the efficacy and validity of the developed model for surgical training.

Main Methods:

• Generated a tumor gel with agar and gelatin, mimicking HGG consistency.
• Selected and optimized concentrations of fluorophores (fluorescein, ICG, europium, Ce6, PpIX) for realistic visualization.
• Injected the gel into animal brains and tested resection under fluorescence microscopy.
• Assessed model validity through surveys with neurosurgeons and trainees, including photobleaching analysis.

Main Results:

• Developed an optimal tumor gel formula with specific agar and gelatin ratios.
• Determined optimal concentration ranges for various fluorophores.
• Found no significant differences in face validity, content validity, or preference among tested fluorophores.
• Identified europium, ICG, and fluorescein as more stable against photobleaching than Ce6 and PpIX.

Conclusions:

• The developed simulation model effectively highlights simulated tumors using different colors (green, yellow, infrared).
• The model demonstrates high face and content validity, proving useful for training intra-axial tumor resection techniques.
• It serves as an effective educational tool for teaching fluorescence-guided surgery nuances and subpial dissection.