Improving outcomes in pediatric endoscopic third ventriculostomy through outcome analysis and surgeon training Breimer, Gerben Eise

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1 University of Groningen Improving outcomes in pediatric endoscopic third ventriculostomy through outcome analysis and surgeon training Breimer, Gerben Eise IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2017 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Breimer, G. E. (2017). Improving outcomes in pediatric endoscopic third ventriculostomy through outcome analysis and surgeon training [Groningen]: University of Groningen Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date:

2 Improving outcomes in pediatric endoscopic third ventriculostomy through outcome analysis and surgeon training Gerben Eise Breimer

3 Improving outcomes in pediatric endoscopic third ventriculostomy through outcome analysis and surgeon training Academic thesis, University of Groningen, Groningen, The Netherlands ISBN Author Cover design Layout Print (gedrukt) (ebook) Gerben Breimer Gerben Breimer and Eelco Roos Eelco Roos Ridderprint BV Copyright 2017, Gerben Breimer, Amsterdam, the Netherlands. All rights reserved. No part of this thesis may be reproduced or transmitted in any form or by any means, without express written permission from the author.

4 Improving outcomes in pediatric endoscopic third ventriculostomy through outcome analysis and surgeon training PhD thesis to obtain the degree of PhD at the University of Groningen on the authority of the Rector Magnificus Prof. E. Sterken and in accordance with the decision by the College of Deans. This thesis will be defended in public on Wednesday, 11 January 2017 at 11:00 hours by Gerben Eise Breimer born on 10 February 1988 in Wageningen

5 Supervisors Prof. Dr. E.W. Hoving Prof. Dr. J.M. Drake Assessment Committee Prof. Dr. O.F. Brouwer Prof. Dr. J.A. Grotenhuis Prof. Dr. S.M. Peerdeman

6 I cannot say whether things will get better if we change; what I can say is that they must change if they are to get better. Georg Christoph Lichtenberg

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8 Contents Acknowledgements 9 List of abbreviations 13 Chapter 1 General introduction 15 Chapter 2 An external validation of the ETVSS for both short-term and long-term predictive adequacy in 104 pediatric patients 31 Chapter 3 Endoscopic third ventriculostomy (ETV) and repeat ETV in pediatric patients: the Dutch experience 47 Chapter 4 Development and content validation of performance assessments for endoscopic third ventriculostomy 71 Chapter 5 Validity Evidence for the Neuro-Endoscopic Ventriculostomy Assessment Tool (NEVAT) 95 Chapter 6 Design and evaluation of a new synthetic brain simulator for endoscopic third ventriculostomy 113 Chapter 7 Simulation-based Education for Endoscopic Third Ventriculostomy: A Comparison Between Virtual and Physical Training Models 129 Chapter 8 Summary and General Discussion 147 Chapter 9 Future Directions 163 Chapter 10 Conclusions 171 Chapter 11 Appendix 1. Nederlandse samenvatting 177 Appendix 2. Lay summary & samenvatting voor leken 179 Appendix 3. Three initial lists for online survey 181 Appendix 4. Feedback on brain simulator 184 Appendix 5. Simulator assessment - VR v physical 185 Appendix 6. Curriculum vitae 189 7

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10 Acknowlegements Acknowledgements Writing this thesis, I realized over and over how lucky I have been in my life on a whole variety of levels. On small scale I have been lucky with the inspiring people I have met, my friends, colleagues and mentors. Without the understanding, patience and kindness of those around me I would not have able to get things done. Eelco Hoving has supported me since the very first time we worked together in Groningen and his positive attitude, work ethos, knowledge, technical skills and integrity are a great example for me and I am very grateful that Dr. Hoving has introduced me to James Drake who is someone I admire and consider to be my mentor. Dr. Drake has helped me in many ways and I am incredibly grateful for his supportive attitude towards me, and for opening doors which would probably have stayed closed if not for him. In Toronto I met many people, one of which is Faizal Haji, he has made serious efforts to explain and guide me through the process of conducting research and writing, always being constructive and offering a helpful hand. All members of the lab of the Centre for Image Guided Innovation and Therapeutic Intervention at the Hospital for Sick Children were tremendously helpful, always available to give advice or suggestions, especially Vivek Bodani and Thomas Looi, Brian Carrillo, Nikoo Saber, Fouzia Khan and Matthew Kang. Most grateful of all I am of meeting Fouzia in the lab in Toronto. On research design and statistics I have had much help from Marjolein Brusse- Keizer (Medisch Spectrum Twente, Enschede), Els Reeuwijk (Universiteit Twente), Riekie de Vet (Vrije Universiteit Amsterdam) and Floor van Leeuwen (Nederlands Kanker Instituut / Antoni van Leeuwenhoek). Margaret Darling helped me with the PubMed search strategies. Fouzia Khan, Jorik Booij, and Roxanne Leung gave much needed advice and suggestions on my written material. The enthusiasm of the international pediatric neurosurgery community has been very stimulating, be it in personal communications, at conferences or at workshops. All the participating residents, fellows and neurosurgeons in Toronto cannot be thanked enough for offering their precious time and for the relevant feedback on the simulator. All the experts contributing to the Delphi study made that project succeed: G. Cinalli, Italy; S. Constantini, Israel; P. Decq, France; S. deribaupierre, Canada; C. DiRocco, Italy; Y. Ersahin, Turkey; J. Grotenhuis, the Netherlands; N. Gupta, United States of America; E. Hoving, the Netherlands; 9

11 I. Pollack, United States of America; C. Sainte-Rose, France; S. Santoreneos, Australia; H. Schroeder, Germany; D. Thompson, United Kingdom; B. Warf, United States of America; J. Wellons, United States of America; S. Zymberg, Brazil. For the validation study in Naples I am much grateful for Piero Spennato, Guiseppe Cinalli and Spyros Sgouros for rating all participants, and without consent of the staff and trainees of the workshop this study would have been impossible. In the Netherlands, for the repeat ventriculostomy study, I received enthusiastic help from Ruben Dammers, Dennis Buis, Peter Woerdeman, Hans Delye, and Sebastian Arts. And for the survey study there were Benjamin Warf, Abhaya Kulkarni, Guiseppe Cinalli, Henry Schroeder, Shlomo Constantini, Jonathan Roth and of course Eelco Hoving and James Drake. It was great that Trudell Medical Marketing Limited provided us the neuroendoscopic equipment required for testing the simulator. Lisa Satterthwaite and the technicians at the University of Toronto surgical skills centre at Mount Sinai Hospital provided much support and also the endoscopic tower and other necessary resources for testing the brain simulator. Eelco Roos helped with the layout and cover of the final printed thesis. On a more general level, there are the obvious lucky breaks such as being born in family with open-minded high educated parents with good jobs and unconditional love and support for my brothers and me, and being brought up in relative quiet times in a rich western world country with a good educational system. A country in which getting accepted into medical school is although it may be better to say was not as competitive as it is in other first world countries like Canada or the United States of America. I realize that I would never have become a medical doctor in these countries (among other things due to mediocre grades in high school). Since I started collecting data for my first paper in 2011 I have found myself in various stages of an education. First I was a student without a clue about what I wanted out of medical school (and life) and having been on the verge of voluntarily dropping out of university many times. In a later phase of medical school I was a student with a plan, a goal and a dream of becoming a neurosurgeon with a strong research background. Then, as a medical doctor, I was a resident with shifting ideas of what I expected from my life and career, culminating in the decision to leave the field of neurosurgery in December 2014, 10

12 Acknowlegements in order to pursue a career in clinical pathology. During these years I had to make many choices: between medical school and another path, between a job as a neurosurgical resident in Groningen and a research position in Toronto, and between neurosurgery and clinical pathology. Writing this all down, knowing that I went with my gut feelings, I feel good about my choices. 11

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14 Abbreviations List of abbreviations 3D ANOVA CI CIGITI CL CSF CT DICOM ELD ETV ETVSS EVD GRS ICC IQR LP MRI NEVAT OR OR OSAT PGY Re-ETV SD SIMONT SPSS STL VP VR Three-Dimensional Analysis of Variance Confidence Interval Centre for Image Guided Innovation and Therapeutic Intervention Checklist Cerebro-Spinal Fluid Computed Tomography Digital Imaging and Communications in Medicine External lumbar puncture Endoscopic Third Ventriculostomy Endoscopic Third Ventriculostomy Success Score External ventricular drain Global Rating Scale Intra-class Correlation Coefficient Interquartile Range Lumbar Puncture Magnetic Resonance Imaging Neuro-Endoscopic Ventriculostomy Assessment Tool Operating Room Odds ratio Objective Structured Assessment Tool Postgraduate Year Repeat ETV Standard Deviation Sinus Model Oto-Rhino Neuro Trainer Statistical Package for the Social Sciences Stereolithography Ventriculo-Peritoneal Virtual Reality 13

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