Development of a Perfusion-Based Cadaveric Simulation Model Integrated into Neurosurgical Training: Feasibility Based On Reconstitution of Vascular and Cerebrospinal Fluid Systems

Operative Neurosurgery. Published online January 1st, 2018 . DOI: 10.1093/ons/opx074.

Gabriel Zada, MD, Joshua Bakhsheshian, MD, Martin Pham, MD, Mike Minneti, BS‡ Eisha Christian, MD, Jesse Winer, MD∗ Aaron Robison, MD, Bozena Wrobel, MD Jonathan Russin, MD, William J. Mack, MD, Steven Giannotta, MD

BACKGROUND: Novel methodologies providing realistic simulation of the neurosurgical operating room environment are currently needed, particularly for highly subspecialized operations with steep learning curves, high-risk profiles, and demands for advanced psychomotor skills.

OBJECTIVE: To describe the development of a curriculum for using perfusion-based cadaveric simulation models in a “Mock Operating Room”for neurosurgical procedures.

METHODS: At the USC Keck School of Medicine Fresh Tissue Dissection Laboratory between 2012 and 2016, 43 cadaveric specimens underwent cannulation of the femoral or carotid artery and artificial perfusion of the arterial system, and/or cannulation of the intradural cervical spine for intrathecal reconstitution of the cerebrospinal fluid (CSF) system. Models were used to train neurosurgical residents in various procedures. Selfassessment of pre- and postprocedure trainee confidence (Likert) scores was compared for each module.

RESULTS: The following novel procedural training methodologies were successfully established: management of an injury to the carotid artery during an endoscopic endonasal approach (n = 12), endoscopic endonasal CSF leak repair (n = 6) with fluorescein perfusion, carotid endarterectomy (n = 4), extracranial-to-intracranial bypass (n = 2), insertion of ventriculostomy catheter (n = 7), spinal laminectomy with durotomy repair (n = 9), and intraventricular neuro-endoscopy with septum pellucidotomy and third ventriculostomy (n=12). In all instances, trainees reported improvement in their postprocedural confidence scores, with mean pre- and postprocedural Likert scores being 2.85 ± 1.09 and 4.14 ± 0.93 (P < .05).

CONCLUSION: Augmentation of fresh cadaveric specimens via reconstitution of vascular and CSF pathways is a feasible methodology for complimenting surgical training in numerous neurosurgical procedures, and may hold implications in the future of neurosurgical resident education.