New laboratory model for neurosurgical training that simulates live surgery

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Object. Laboratory training models are essential for developing and refining surgical skills, especially for microsurgery. The closer to live surgery the model is, the greater the benefit. In this paper the authors introduce a cadaver model with unique characteristics: dynamic filling of the cerebral vasculature with colored liquid and clear fluid filling of the arachnoid cisterns. This model is distinctive and has great practical value for training in a wide range of surgical procedures.

Methods. Cadaveric heads were prepared for surgical procedures in the following manner: the carotid arteries (CAs) and vertebral arteries (VAs) in the neck were cannulated, as were the internal jugular veins (JVs) on both sides. Two tubes were introduced into the spinal canal and each one was advanced into one of the cerebellopontine angle cisterns. A CA, VA, or both were then connected to a reservoir containing light red fluid and a pressure of 80 to 120 mm Hg and a pulse rate of 60 beats/minute were established using a pump. The JV on the side currently being dissected was connected to a reservoir containing dark red fluid and kept at a pressure between 20 and 40 mm Hg. The remaining vessels were clamped in the neck. The cisternal tubes were connected to a reservoir of clear fluid that was regulated by an adjustable flow. Nine trainees have tested this model on eight specimens by practicing a variety of surgical procedures and maneuvers, including craniotomies; hemostasis; cisternal and vascular dissection; vascular anastomosis and repair; establishment of arterial bypasses; aneurysm creation, dissection, and clipping; management of an aneurysm rupture; intraparenchymal resection such as amygdalohippocampectomy; ventricular endoscopy and third ventriculostomy; cavernous sinus and skull base approaches; and resection of artificial tumors in the basal cisterns.

Conclusions. This model mimics the normal human anatomy and dynamic vascular filling found in real surgery and presents it from the training perspective, allowing a wide range of skill development and repeated practice. It provides an alternative model to laboratory animals. It is inexpensive and readily available, and has great value for the acquisition and refinement of surgical skills that are not only specific to neurosurgery, but are applicable to other surgical disciplines.

Article Information

Address reprint requests to: Ossama Al-Mefty, M.D., Department of Neurosurgery, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 507, Little Rock, Arkansas 72205. email: keelandamye@uams.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Photograph showing tubes inside the cannulated vessels before connecting them to the fluid reservoirs. C = inside the CA; J = inside the JV; S = inside the spinal canal; and V = inside the VA.

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    Photograph demonstrating the connections between the cadaveric head and the reservoirs.

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    Training session photographs showing opening and hemostasis. A and B: Bleeding meningeal arteries. C and D: The same arteries after coagulation. E: Coagulating pial vessels. F: Scalp hemostasis achieved using Raney clips and coagulation of vessels. Arrow indicates a bleeding jet.

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    The brain surface as it appears upon opening the dura mater. Note the lifelike filled vessels.

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    Examples of end-to-end and end-to-side anastomoses achieved by attaching the STA to the MCA on one of the cortical branches of the MCA.

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    Training session photographs showing thrombectomy and arterial repair of one of the M2 branches. A: Thrombosis in the MCA branch. B: Temporary clipping. C: Arteriotomy. D: Removal of the thrombus. E: Establishment of flow through a patent vessel after arteriography.

  • View in gallery

    Management of aneurysm bleeding. A: Artificial aneurysm located on the MCA bifurcation. B: Bleeding jet from the punctured aneurysm (arrow). C: Temporary clipping of the MCA. D: Clipping of the aneurysm neck.

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    Training session photograph obtained during the resection of an artificial parasellar tumor (T). C = carotid artery; II = optic nerve.

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    Photograph demonstrating cannulation of the CA in a brain obtained at autopsy.

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