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

Abstract

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.

ICAR: endoscopic skull‐base surgery

“…In addition to avoidance of ICA injury, an increased preparedness for its management may improve outcomes after a carotid artery injury . To achieve this goal, several endonasal carotid injury models have been developed . These include the previously mentioned sheep model, perfusion‐based cadaveric models, and noncadaveric synthetic models.…”

Systematic review of the current status of cadaveric simulation for surgical training

“…Fifty‐one studies were included in the review, of which 47 were full‐text original research articles and four were conference posters. The main characteristics of studies, including OCEBM and mean MERSQI scores are shown in Tables S2 – S5 (supporting information).…”

“…Various score‐based methods were also used, including procedure scores, global rating scale (GRS), OSATS (Objective Structured Assessment of Technical Skills in Surgery) and the GOALS (Global Operative Assessment of Laparoscopic Skills) scale. Seven of the 23 studies were RCTs and 16 were cohort studies. Of the seven RCTs, three compared cadaveric simulation with no simulation training, and four compared cadaveric simulation with low‐fidelity simulation.…”

“…Three studies compared inexperienced versus experienced performance, one compared behaviour change in cadaveric simulation‐trained versus low‐fidelity simulation‐trained cohorts, and one compared within‐subject performance change after cadaveric simulation training. Eleven were non‐comparative descriptive studies.…”

“…A wide variety of cadaveric models were used in the included studies. Three studies used innovative techniques to perfuse or reconstitute cadaveric material for training purposes, to improve the fidelity of the simulation. These studies were all in the field of neurosurgery, and involved cannulation of the great vessels of the neck to allow pulsatile perfusion of cadaveric heads with an artificial blood substitute.…”