A Perfusion-based Human Cadaveric Model for Management of Carotid Artery Injury during Endoscopic Endonasal Skull Base Surgery

Pham, Martin H.; Kale, Aydemir; Marquez, Yvette; Winer, Jesse L.; Lee, Brian; Harris, Brianna; Minnetti, Michael; Carey, Joseph N.; Giannotta, Steven L.; Zada, Gabriel

doi:10.1055/s-0034-1372470

Cited by 52 publications

(36 citation statements)

References 19 publications

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“…Despite all of these obstacles, the educational benefit is indisputable. There have also been attempts to perfuse cadavers to bring about a more realistic approach in human brains such as endoscopic skull base procedures [62] or aneurysm surgery [63].…”

Section: Discussionmentioning

confidence: 99%

Neurosurgical cadaveric and in vivo large animal training models for cranial and spinal approaches and techniques — a systematic review of the current literature

Morosanu

Nicolae

Moldovan

et al. 2018

Neurol Neurochir Pol.

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Introduction. Due to its high complexity, neurosurgery consists of a demanding learning curve that requires intense training and a deep knowledge of neuroanatomy. Microsurgical skill development can be achieved through various models of simulation, but as human cadaveric models are not always accessible, cadaveric animal models can provide a reliable environment in which to enhance the acquisition of surgical dexterity. The aim of this review was to analyse the current role of animal brains in laboratory training and to assess their correspondence to the procedures performed in humans. Material and methods. A Pubmed literature search was performed to identify all the articles concerning training cranial and spinal techniques on large animal heads. The search terms were 'training model' , and 'neurosurgery' in association with 'animal' , 'sheep' , 'cow' , and 'swine'. The exclusion criteria were articles that were on human brains, experimental fundamental research, or on virtual simulators. Results. The search retrieved 119 articles, of which 25 were relevant to the purpose of this review. Owing to their similar neuroanatomy, bovine, porcine and ovine models prove to be reliable structures in simulating neurosurgical procedures. On bovine skulls, an interhemispheric transcalosal and retrosigmoid approach along with different approaches to the Circle of Willis can be recreated. Ovine model procedures have varied from lumbar discectomies on sheep spines to craniosynostosis surgery, whereas in ex vivo swine models, cadaveric dissections of lateral sulcus, median and posterior fossa have been achieved. Conclusions. Laboratory training models enhance surgical advancements by familiarising trainee surgeons with certain neuroanatomical structures and promoting greater surgical dexterity. The accessibility of animal brains allows trainee surgeons to exercise techniques outside the operating theatre, thus optimising outcomes in human surgical procedures.

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Section: Discussionmentioning

confidence: 99%

Neurosurgical cadaveric and in vivo large animal training models for cranial and spinal approaches and techniques — a systematic review of the current literature

Morosanu

Nicolae

Moldovan

et al. 2018

Neurol Neurochir Pol.

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“…The model is more cost-effective than whole body cadavers and has the potential to be used with SimMan technology to replicate clinically relevant changes in vital signs. 33 The simulation model we describe is highly realistic and provides an excellent opportunity for teaching complex surgical skills. As with any pilot study, there are some study limitations.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Management of Cavernous Carotid Surgical Complications: Evaluation of a Simulated Perfusion Model

et al. 2017

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Objective Endoscopic surgical treatment of pituitary tumors, lateral invading tumors, or aneurysms requires surgeons to operate adjacent to the cavernous sinus. During these endoscopic endonasal procedures, the carotid artery is vulnerable to surgical injury at its genu. The objective of this simulation model was to evaluate trainees regarding management of a potentially life-threatening vascular injury. Methods Cadaveric heads were prepared in accordance with the Oregon Health & Science University body donation program. An endoscopic endonasal approach was used, and a perfusion pump with a catheter was placed in the ipsilateral common carotid artery at its origin in the neck. Learners used a muscle graft to establish vascular control and were evaluated over 3 training sessions. Simulation assessment, blood loss during sessions, and performance metric data were collected for learners. Results Vascular control was obtained at a mean arterial pressure of 65 mm Hg using a muscle graft correctly positioned at the arteriotomy site. Learners improved over the course of training, with senior residents (n = 4) performing better across all simulation categories (situation awareness, decision making, communications and teamwork, and leadership); the largest mean difference was in communication and teamwork. Additionally, learner performance concerning blood loss improved between sessions (t = 3.667, P < 0.01). Conclusions In this pilot endoscopic endonasal simulation study, we successfully demonstrate a vascular complication perfusion model. Learners were able to gain direct applicable expertise in endoscopic endonasal techniques, instrumentation use, and teamwork required to optimize the technique. Learners gained skills of vascular complication management that transcend this model.

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“…Moreover, storage time of fresh tissues is short. Similarly, the majority of researchers have filled the vessels of embalmed human heads or whole bodies with aqueous solutions [9,10,11,12,14,16,17,19,20,21,23,33,34]. Unlike water, hydrophobic perfusates (e.g., PP) are more confined to vessels, and the capacity to extravasate depends on their viscosity [18,29,35].…”

Section: Discussionmentioning

confidence: 99%

“…Hemostasis can be accomplished on reperfused skin and subcutaneous tissue. This skill can also be practiced on reperfused human training models using tap water [9,19,21]. Dissection of physiologically filled vessels, and performance and evaluation of vascular anastomoses can also be performed.…”

Section: Discussionmentioning

confidence: 99%

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Lifelike Vascular Reperfusion of a Thiel-Embalmed Pig Model and Evaluation as a Surgical Training Tool

Willaert

Tozzi²,

Hoof³

et al. 2016

Eur Surg Res

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Background: Vascular reperfusion of Thiel cadavers can aid surgical and anatomical instruction. This study investigated whether ideal embalming circumstances provide lifelike vascular flow, enabling surgical practice and enhancing anatomical reality. Methods: Pressure-controlled pump-driven administration of blue embalming solution was assessed directly postmortem in a pig model (n = 4). Investigation of subsequent pump-driven vascular injection of red paraffinum perliquidum (PP) included assessment of flow parameters, intracorporeal distribution, anatomical alterations, and feasibility for surgical training. The microscopic distribution of PP was analyzed in pump-embalmed pig and gravity-embalmed human small intestines. Results: Embalming lasted 50-105 min, and maximum arterial pressure was 65 mm Hg. During embalming, the following consecutive alterations were observed: arterial filling, organ coloration, venous perfusion, and further tissue coloration during the next weeks. Most organs were adequately preserved. PP generated low arterial pressures (<30 mm Hg) and drained through the venous cannula. Generally, realistic reperfusion and preservation of original anatomy were observed, but leakage in the pleural, abdominal, and retroperitoneal cavities occurred, and computed tomography showed edematous spleen and liver. Reduction of arterial flow rates after venous drainage is a prerequisite to prevent anatomical deformation, allowing simulation of various surgeries. In pump-embalmed pig small intestines, PP flowed from artery to vein through the capillaries without extravasation. In contrast, arterioles were blocked in gravity-embalmed human tissues. Conclusions: In a pig model, immediate postmortem pressure-controlled pump embalming generates ideal circumstances for (micro)vascular reperfusion with PP, permitting lifelike anatomy instruction and surgical training.

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A Perfusion-based Human Cadaveric Model for Management of Carotid Artery Injury during Endoscopic Endonasal Skull Base Surgery

Cited by 52 publications

References 19 publications

Neurosurgical cadaveric and in vivo large animal training models for cranial and spinal approaches and techniques — a systematic review of the current literature

Neurosurgical cadaveric and in vivo large animal training models for cranial and spinal approaches and techniques — a systematic review of the current literature

Endoscopic Management of Cavernous Carotid Surgical Complications: Evaluation of a Simulated Perfusion Model

Lifelike Vascular Reperfusion of a Thiel-Embalmed Pig Model and Evaluation as a Surgical Training Tool

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