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

Abstract

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.

Evaluation of simulation models in neurosurgical training according to face, content, and construct validity: a systematic review

“…Placenta models [ 13 , 22 ] successfully discriminated between competence levels, whilst the live rat models confirmed skill improvement after practicing with the model [ 22 , 33 ]. Our results are consistent with literature findings that tissue and animal models are favoured due to neuroanatomical and neurovascular similarities [ 44 ]. Specifically, the large- and small-necked aneurysms present in placenta have been an excellent model in simulating microsurgical skills such as aneurysm clipping [ 41 ].…”

“…Our systematic review highlighted early evidence of the feasibility and utility of using simulation models in neurosurgical training and education. Existing systematic reviews [ 9 , 16 , 30 , 44 , 53 , 59 ] have evaluated the utility and efficacy of simulation models in neurosurgical education and training. However, to our knowledge, there are no previous reviews assessing these 4 neurosurgical procedures/skills: craniotomy/burr hole drilling, aneurysm clipping, vessel suturing, and tumour resection using face, content, and construct validity.…”

In vivo goat brain model for neurosurgical training

“…Due to their similar neuroanatomy, the bovine, ovine, and porcine models have proven to be reliable structures in neurosurgical simulations. [7] e bovine brain can reproduce the interhemispheric, transcallosal, and retrosigmoid approaches, along with various approaches to the ring of Willis. [5,10] In ovine models, lumbar discectomy and craniosynostosis surgery have been reported.…”

In vivo Diffusion Tensor Magnetic Resonance Tractography of the Sheep Brain: An Atlas of the Ovine White Matter Fiber Bundles

“…Most importantly, the gyrencephalic ovine brain is anatomically and functionally more similar to human brain if compared to the lissencephalic brain of rodents and rabbits, due to its relatively large size and the presence of sulci (21). Further similar features to humans are evident in electroencephalographic records, neuroradiological features, and neurovascular structures (22), thus making the ovine model of particular relevance in the field of experimental neuroscience. For example, it has been studied in the context of epilepsy (23), neuropsychiatry (24), traumatic brain injury (25), and neurodegenerative diseases (26, 27).…”