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Du Cheng, Melissa Yuan, Imali Perera, Ashley O’Connor, Alexander I. Evins, Thomas Imahiyerobo, Mark Souweidane and Caitlin Hoffman

toward overcoming these educational barriers. In neurosurgery, cadaveric specimens have traditionally been used for higher-volume exposure and repetitive experience with surgical procedures and techniques. Over the past 2 decades, the development of 3D printed training models has increased exponentially in the medical field in general, but also specifically within neurosurgery. 2 , 3 , 12 , 14 , 17–19 Even within the subspecialty of pediatric neurosurgery, several physical simulators have been developed, for example, for pediatric lumbar spine pathologies, ventricular

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Claudia L. Craven, Martyn Cooke, Clare Rangeley, Samuel J. M. M. Alberti and Mary Murphy

perform an operation for the first time. Ultimately, all British trainees need to be competent in emergency pediatric neurosurgery before completion of their training. Training challenges could be addressed by the application of a high-fidelity training model to enable preoperative rehearsal. There is currently no existing infant model that enables a wide range of procedures to be performed. There is a paucity of pediatric neurosurgical synthetic training models and particularly infant models, an area in which simulation is possibly needed the most. We developed a high

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Tufan Hicdonmez, Turgay Parsak and Sebahattin Cobanoglu

N eurosurgery residents need many years of practice to develop neurosurgical skills, and laboratory training models are essential for developing and refining surgical skills before their application in clinical neurosurgery. Laboratory training is fundamental for acquiring familiarity with the techniques of surgery and skill in handling microinstruments. 1 Several models have been developed to help neurosurgery residents and neurosurgeons gain experience with neuro- and microsurgical procedures; the majority of these models involve the use of tissue from

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Eisha A. Christian, Joshua Bakhsheshian, Ben A. Strickland, Vance L. Fredrickson, Ian A. Buchanan, Martin H. Pham, Andrew Cervantes, Michael Minneti, Bozena B. Wrobel, Steven Giannotta and Gabriel Zada

suprasellar arachnoid ( Fig. 2 ). Trainees then practiced repairing the CSF leak using a combination of fat, fascia lata, and pedicled nasoseptal flaps ( Fig. 3 ). Standard CSF repair techniques included a 2-layer fascial apposition method, as described by Couldwell et al., in which the sella turcica was packed with a fat graft and covered using a pedicled nasoseptal flap ( Video 1 ). 5 VIDEO 1. Video demonstrating the use of a perfusion-based human cadaveric specimen as a simulation training model in repairing CSF leaks during endoscopic endonasal skull base surgery. The

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Evgenii Belykh, Ting Lei, Sam Safavi-Abbasi, Kaan Yagmurlu, Rami O. Almefty, Hai Sun, Kaith K. Almefty, Olga Belykh, Vadim A. Byvaltsev, Robert F. Spetzler, Peter Nakaji and Mark C. Preul

models are still less than ideal for various reasons, such as vessel diameter diversity, cost-effectiveness, artifacts due to storage (e.g., freezing), or poor tactile simulation of human arteries. We have developed microvascular anastomosis training models that use human and bovine placentas, but there have been no analyses that assess the usefulness of these models for neurovascular training based on the histologic characteristics of the tissues or validation of the actual surgical techniques, as appropriate. In this article, we describe our experience and validation

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Michael C. Dewan, Justin Onen, Hansen Bow, Peter Ssenyonga, Charles Howard and Benjamin C. Warf

, initial closure of MM, and longer-term management of children with MM. Upon completion of the program, trainees return to their home institution as partners in a global network of pediatric neurosurgeons to implement the knowledge and skills gained for the benefit of children in their home country. CHSB ensures that the trainee has access to the necessary equipment and also provides an on-site clinical care coordinator to assist with patient follow-up and data collection. FIG. 1. CHSB training model flow diagram. Prospective surgeons undergo detailed screening to ensure

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Marcelo Magaldi Ribeiro de Oliveira, Arthur Nicolato, Marcilea Santos, Joao Victor Godinho, Rafael Brito, Alexandre Alvarenga, Ana Luiza Valle Martins, André Prosdocimi, Felipe Padovani Trivelato, Abdulrahman J. Sabbagh, Augusto Barbosa Reis and Rolando Del Maestro

training model should be inexpensive, readily available, and have haptic characteristics similar to those encountered in the endovascular treatment of human disorders. Animal and computer-based models have been developed for this purpose. 3 , 5 , 7 While each model has certain advantages and disadvantages, it is difficult to reproduce all the haptic qualities necessary for these procedures using virtual simulators or animal models. 4 , 6–8 Thus, it is necessary to continue to develop and research new techniques for neurointerventional training. In this article, we

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Emad Aboud, Ossama Al-Mefty and M. Gazi Yaşargil

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.

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Skull base tumor model

Laboratory investigation

Cristian Gragnaniello, Remi Nader, Tristan van Doormaal, Mahmoud Kamel, Eduard H. J. Voormolen, Giovanni Lasio, Emad Aboud, Luca Regli, Cornelius A. F. Tulleken and Ossama Al-Mefty

R ecently , increasing attention has been placed on the development of training models to improve both microsurgical skills and anatomical knowledge of neurosurgical trainees. Although excellent spinal and cranial models have been presented in the literature, most of them have focused on performing surgical approaches in the setting of normal surgical anatomy. 2 , 3 , 11 , 16 Very few of the currently available models expose the trainee to the anatomy distorted by a space-occupying lesion. 1 , 10 The familiarity of the neurosurgical trainee with

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Adib A. Abla, Timothy Uschold, Mark C. Preul and Joseph M. Zabramski

, Uschold. References 1 Colpan ME , Slavin KV , Amin-Hanjani S , Calderon-Arnuphi M , Charbel FT : Microvascular anastomosis training model based on a turkey neck with perfused arteries . Neurosurgery 62 : 5 Suppl 2 ONS407 – ONS411 , 2008 2 EC/IC Bypass Study Group : Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial . N Engl J Med 313 : 1191 – 1200 , 1985 3 Fiorella D , Levy EI , Turk AS , Albuquerque FC , Niemann DB , Aagaard-Kienitz B