“Live cadavers” for training in the management of intraoperative aneurysmal rupture

Aboud, Emad; Aboud, Ghaith; Al‐Mefty, Ossama; Aboud, Talal; Rammos, Stylianos K.; Abolfotoh, Mohammad; Hsu, Sanford P.C.; Koga, Sebastian F.; Arthur, Adam S; Krisht, Ali F.

doi:10.3171/2014.12.jns141551

Cited by 52 publications

(44 citation statements)

References 24 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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“…Each artery was dissected using a surgical microscope (OPMI VARIO 700). An aneurysm was created on both the left and the right MCAs at the M 1 bifurcation as described by Aboud et al 1 The distal MCA was perfused with red color dye (gouache color, Nanchang Lan Po Pen & Painting Material Co.) diluted in normal saline at a proportion of 1:5 ml to simulate arterial flow and aneurysm bleeding. Arterial pressure simulation was accomplished by placing a saline bag 120 cm above the cadaver head.…”

Section: Human Cadaver Aneurysm Surgery Simulationmentioning

confidence: 99%

Learning brain aneurysm microsurgical skills in a human placenta model: predictive validity

Oliveira

Ferrarez²,

Ramos³

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Surgery for brain aneurysms is technically demanding. In recent years, the process to learn the technical skills necessary for these challenging procedures has been affected by a decrease in the number of surgical cases available and progressive restrictions on resident training hours. To overcome these limitations, surgical simulators such as cadaver heads and human placenta models have been developed. However, the effectiveness of these models in improving technical skills is unknown. This study assessed concurrent and predictive validity of brain aneurysm surgery simulation in a human placenta model compared with a "live" human brain cadaveric model. METHODS Two human cadaver heads and 30 human placentas were used. Twelve neurosurgeons participated in the concurrent validity part of this study, each operating on 1 human cadaver head aneurysm model and 1 human placenta model. Simulators were evaluated regarding their ability to simulate different surgical steps encountered during real surgery. The time to complete the entire aneurysm task in each simulator was analyzed. The predictive validity component of the study involved 9 neurosurgical residents divided into 3 groups to perform simulation exercises, each lasting 6 weeks. The training for the 3 groups consisted of educational video only (3 residents), human cadaver only (3 residents), and human placenta only (3 residents). All residents had equivalent microsurgical experience with superficial brain tumor surgery. After completing their practice training, residents in each of the 3 simulation groups performed surgery for an unruptured middle cerebral artery (MCA) aneurysm, and their performance was assessed by an experienced vascular neurosurgeon who watched the operative videos. RESULTS All human cadaver heads and human placentas were suitable to simulate brain aneurysm surgery. In the concurrent validity portion of the experiment, the placenta model required a longer time (p < 0.001) than cadavers to complete the task. The placenta model was considered more effective than the cadaver model in simulating sylvian fissure splitting, bipolar coagulation of oozing microvessels, and aneurysm neck and dome dissection. Both models were equally effective in simulating neck aneurysm clipping, while the cadaver model was considered superior for simulation of intraoperative rupture and for reproduction of real anatomy during simulation. In the predictive validity portion of the experiment, residents were evaluated for 4 tasks: sylvian fissure dissection, microvessel bipolar coagulation, aneurysm dissection, and aneurysm clipping. Residents trained in the human placenta simulator consistently had the highest overall performance scores when compared with those who had trained in the cadaver model and those who had simply watched operative videos (p < 0.001). CONCLUSIONS The human placenta biological simulator provides excellent simulation for some critical tasks of aneurysm surgery such as splitting of the sylvian fissure, dissection of the aneurysm neck and d...

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“…Demographic details are presented in Table 1. An average of 12 surgeons participated per session (range [7][8][9][10][11][12][13][14][15][16][17][18][19]. A mixture of residents of all levels (n = 43, 59.7%) and attendings (n = 29, 40.3%) participated.…”

Section: Resultsmentioning

confidence: 99%

“…The results of a surgeon's inability to meet the significant cognitive and procedural challenge of an ICAI can be catastrophic. In Laws's description of vascular complications, 16.7% (1 of 6) of patients died during their hospitalization. 4 In other series, up to two thirds may have had permanent neurologic injury.…”

mentioning

confidence: 99%

Costs and training results of an objectively validated cadaveric perfusion‐based internal carotid artery injury simulation during endoscopic skull base surgery

Donoho

Johnson

Hur

et al. 2019

Int Forum Allergy Rhinol

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Background: Internal carotid artery injury (ICAI) is a rare, life-threatening complication of endoscopic endonasal approaches (EEAs). High-fidelity simulation methods exist, but optimization of the training cohort, training paradigm, and costs of simulation training remain unknown.Methods: Using our previously validated, high-fidelity, perfused-cadaver model, participants a empted to manage a simulated ICAI. A er a brief instructional video and coaching, the simulation was repeated. Training success was defined as successful ICAI control on the second a empt a er failure on the initial a empt. Marginal costs were measured.Results: Seventy-two surgeons participated in the standardized simulation, which lasted ࣘ15 minutes. The marginal cost of simulation was $275.00 per surgeon. A total of 44.4% (n = 32) succeeded on the first a empt before training (previously proficient); 44.4% (n = 32) failed the first a empt, but succeeded a er training (training successes); and 11.1% (n = 8) failed both a empts. The cost per training success was $618.75. Forty-two surgeons had never treated an ICAI, with 24 becoming training successes (57.1% overall, 82.8% when excluding previously proficient surgeons). Twenty-nine had experienced a real or simulated ICAI, with 8 (27.6% overall, 72.7% excluding previously proficient surgeons) becoming training successes. The cost per training success was lowest in the ICAI-naive group ($481.25) and highest among surgeons with simulated and real ICAI experience ($1650). Conclusions:Surgeons can be trained to manage ICAI in a single, brief, low-cost session. Although all groups improved, training an ICAI-naive or resident cohort may maximize training results. A perfused-cadaver model is a reproducible, realistic, and low-cost method for training surgeons to manage life-threatening ICAI during an EEA. C 2019 ARS-AAOA, LLC. How to Cite this Article: Donoho DA, Johnson CE, Hur KT, et al. Costs and training results of an objectively validated cadaveric perfusionbased internal carotid artery injury simulation during endoscopic skull base surgery. Int Forum Allergy Rhinol. 2019;9:787-794.

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“Live cadavers” for training in the management of intraoperative aneurysmal rupture

Cited by 52 publications

References 24 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

Learning brain aneurysm microsurgical skills in a human placenta model: predictive validity

Costs and training results of an objectively validated cadaveric perfusion‐based internal carotid artery injury simulation during endoscopic skull base surgery

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