Flexible Neuroendoscopic Training System Using a 3-dimensional Printed Brain Model with Side-view Visualization of Ventricular Wall Contact

We developed and evaluated a neuroendoscopic training system using a 3-dimensional printed brain model with a water-filled ventricular environment and a side-view visualization structure. A 3-dimensional printed neuroendoscopic training model was fabricated from preoperative computed tomography and magnetic resonance imaging data. A soft polyurethane brain model immersed in water within a transparent container was used to simulate cerebrospinal fluid conditions. Ten neurosurgeons evaluated anatomical reproducibility and neuroendoscopic manipulation skills using a 4-point scale. Evaluated items included identification of intraventricular anatomical structures, use of basic neuroendoscopic manipulation techniques, and avoidance of ventricular wall contact. Anatomical structures within the lateral and third ventricles were generally well reproduced, although several deep structures in the posterior third ventricle received lower ratings. Basic neuroendoscopic manipulation techniques received favorable self-evaluations, whereas ventricular wall contact avoidance scores were lower. Favorable ratings were observed in 92.5% of evaluations for basic neuroendoscopic manipulation techniques compared with 37.5% for ventricular wall contact avoidance, demonstrating a significant difference between the 2 categories (p = 0.002). Educational usefulness of the training system received a median score of 3 (interquartile range, 3-4), with a favorable evaluation rate of 80%. This exploratory study suggests that this training system may be useful not only for acquiring basic neuroendoscopic skills but also for visualizing and learning how to avoid ventricular wall contact during neuroendoscopic procedures.