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Ito Y, Hafez A, Hosoo H, Marushima A, Matsumaru Y, Ishikawa E. Effect of Sleep Deprivation on Simulated Microsurgical Vascular Anastomosis. J Neurol Surg A Cent Eur Neurosurg 2024; 85:389-395. [PMID: 37023791 DOI: 10.1055/a-2070-4716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND The effects of sleep deprivation on surgical performance have been well documented. However, reports on the effects of sleep deprivation on microneurosurgery are limited. This study aimed to investigate the effects of sleep deprivation on microneurosurgery. METHODS Ten neurosurgeons participated in the anastomosis of a vessel model using a microscope in sleep-deprived and normal states. We evaluated the procedure time (PT), stitch time (ST), interval time (IT), number of unachieved movements (NUM), leak rate, and practical scale for anastomosis quality assessment. Each parameter was compared between normal and sleep-deprived states. Subanalyses were performed on the two groups based on PT and NUM under the normal state (proficient and nonproficient groups). RESULTS Although no significant differences were noted in PT, ST, NUM, leak rate, or practical scale, IT was significantly prolonged under sleep deprivation compared with the normal state (mean: 258.8 ± 94.0 vs. 199.3 ± 74.9 seconds; p = 0.02). IT was significantly prolonged under sleep deprivation in the nonproficient group based on both PT and NUM (PT: 234.2 ± 71.6 vs. 321.2 ± 44.7 seconds, p = 0.04; NUM: 173.3 ± 73.6 vs. 218.7 ± 97.7; p = 0.02), whereas no significant difference was observed in the proficient group (PT: 147.0 ± 47.0 vs. 165.3 ± 61.1 seconds, p = 0.25; NUM: 173.3 ± 73.6 vs. 218.7 ± 97.7; p = 0.25). CONCLUSIONS Although IT was significantly prolonged under sleep deprivation in the nonproficient group, there was no decline in performance skills in either the proficient or nonproficient group. The effect of sleep deprivation may require caution in the nonproficient group, but it is possible that certain microneurosurgical outcomes can be achieved under sleep deprivation.
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Affiliation(s)
- Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Ahmad Hafez
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Hisayuki Hosoo
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Vasankari V, Hafez A, Pohjola A, Auricchio AM, Calvanese F, Rossmann T, Veldeman M, Badic I, Netti E, Rautalin I, Nurminen V, Raj R, Niemelä M, Lehecka M. Even short-term training improves the skills of novice exoscope users: a prospective laboratory experiment. Acta Neurochir (Wien) 2024; 166:118. [PMID: 38427127 PMCID: PMC10907429 DOI: 10.1007/s00701-024-05975-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/14/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The surgical 3D exoscopes have recently been introduced as an alternative to the surgical microscopes in microneurosurgery. Since the exoscope availability is still limited, it is relevant to know whether even a short-term exoscope training develops the skills needed for performing exoscope-assisted surgeries. METHODS Ten participants (six consultants, four residents) performed two laboratory bypass test tasks with a 3D exoscope (Aesculap Aeos®). Six training sessions (6 h) were performed in between (interval of 2-5 weeks) on artificial models. The participants were divided into two groups: test group (n = 6) trained with the exoscope and control group (n = 4) with a surgical microscope. The test task was an artificial end-to-side microsurgical anastomosis model, using 12 interrupted 9-0 sutures and recorded on video. We compared the individual as well as group performance among the test subjects based on suturing time, anastomosis quality, and manual dexterity. RESULTS Altogether, 20 bypass tasks were performed (baseline n = 10, follow-up n = 10). The median duration decreased by 28 min and 44% in the exoscope training group. The decrease was steeper (29 min, 45%) among the participants with less than 6 years of microneurosurgery experience compared to the more experienced participants (13 min, 24%). After training, the participants with at least 1-year experience of using the exoscope did not improve their task duration. The training with the exoscope led to a greater time reduction than the training with the microscope (44% vs 17%). CONCLUSIONS Even short-term training with the exoscope led to marked improvements in exoscope-assisted bypass suturing among novice microneurosurgeons. For the more experienced participants, a plateau in the initial learning curve was reached quickly. A much longer-term effort might be needed to witness further improvement in this user group.
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Affiliation(s)
- Ville Vasankari
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland.
| | - Ahmad Hafez
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
| | - Anni Pohjola
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
| | - Anna Maria Auricchio
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Calvanese
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
| | - Tobias Rossmann
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Michael Veldeman
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Ines Badic
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
- Sigmund Freud University Vienna, Vienna, Austria
| | - Eliisa Netti
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
| | - Ilari Rautalin
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Ville Nurminen
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
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Jung J, Jeong D. A comparison study of vessel twisting by different microsurgical suture techniques in a chicken wing artery side to side bypass training model. J Cerebrovasc Endovasc Neurosurg 2023; 25:260-266. [PMID: 37188332 PMCID: PMC10555616 DOI: 10.7461/jcen.2023.e2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE Microvascular anastomosis, particularly side-to-side (STS) bypass, is a complex surgical procedure. While several suture techniques exist, none of them is superior to the others. We assessed the association between various STS bypass techniques and vessel twisting using chicken wing training models. METHODS Three suture techniques were compared over an anterior wall suture procedure. The unidirectional continuous suture (UCS) group used a downward "right-to-left" continuous suture. The reverse continuous suture (RCS) group used a downward "left-to-right" continuous suture. The interrupted suture (IS) group used the standard interrupted suture. The number of samples in each of the three groups was 30 (n=90). We compared the incidence of vessel twisting and rotation angles across groups. RESULTS Vessel twisting occurred in 96.7%, 56.7%, and 0% of the cases in the UCS, IS, and RCS groups, respectively. The incidence of vessel twisting differed significantly in all 3 groups (p<0.001), with an apparent trend (p=0.002). The mean rotation angles were 201˚±90.6˚, 102˚±107.6˚, and 0˚ in the UCS, IS, and RCS groups, respectively, which were significantly different (p<0.001). On excluding cases without twisting, the rotation angles of twisted vessels in the UCS and IS groups were 207.9˚±83.7˚ and 180˚±77.9˚, respectively, which yielded a significant difference between these groups (p<0.001). CONCLUSIONS We found that the incidence and trend of vessel twisting differed significantly across suture techniques. The RCS technique may aid in preventing vessel twisting in the STS bypass procedure.
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Affiliation(s)
- Junho Jung
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwasung, Korea
| | - Donghwan Jeong
- Department of Neurosurgery, Danwon Hospital, Ansan, Korea
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Xiao Z, Wang J, Guo J, Pan Q. Three types of end-to-side microvascular anastomosis training models using rat common iliac arteries. Front Surg 2023; 10:1122551. [PMID: 37009619 PMCID: PMC10062452 DOI: 10.3389/fsurg.2023.1122551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
Background: Instead of only practicing these perfectly matched end-to-side anastomoses in microsurgical laboratories, we must learn how to perform these so-called “imperfect” end-to-side anastomoses in the laboratory.MethodsThree types of end-to-side microvascular anastomoses using the rat common iliac artery (CIA), one with the proximal end of the CIA to the contralateral side of the CIA, another with the distal end of the CIA to the contralateral side of the CIA, and the third with the distal end of the CIA to the ipsilateral side of the common iliac vein (CIV), were presented to simulate different end-to-side anastomosis situations in a microsurgical laboratory. Diameters of CIA and CIV, distances between temporary clips, the length of arteriotomy or venotomy, and the distribution of stitches were recorded. The patency rates were evaluated immediately after the anastomosis was completed and 30 min later. After animal euthanasia, the donor vessel was cut close to the anastomotic site, and the orifice size and intimal attachment were evaluated by inspecting them through inside the vessel.ResultsThe diameters of the CIA and CIV were 0.8–1.2 mm and 1.2–1.5 mm, respectively. The end-to-side microvascular anastomosis arteriotomy or venotomy is approximately 2.00–2.50 mm, the distance between the aneurysm clips on the recipient CIA or CIV is approximately 4.00–7.00 mm, and the distance between the corner of the arteriotomy or venotomy and the temporary aneurysm clip was 1.00–3.00 mm. Three types of end-to-side anastomoses using the CIA were successfully performed, and 100% patency rates were achieved immediately and 30 min postoperatively. Good distribution of stitches, wide orifice, and intimal attachment were recorded in the study in all groups.ConclusionsThree types of end-to-side anastomoses using rat CIAs could be efficiently used to mimic three different anastomotic situations.
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Affiliation(s)
- Zongyu Xiao
- Department of Neurosurgery, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
- Correspondence: Zongyu Xiao
| | - Ji Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jingpeng Guo
- Department of Neurosurgery, Fuyang People’s Hospital, Fuyang, China
| | - Qi Pan
- Department of Neurosurgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
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Hafez A, Haeren R, Huhtakangas J, Nurminen V, Niemelä M, Lehecka M. 3D Exoscopes in Experimental Microanastomosis: A Comparison of Different Systems. Life (Basel) 2023; 13:life13020584. [PMID: 36836941 PMCID: PMC9966143 DOI: 10.3390/life13020584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/02/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
Background: In recent years, three-dimensional exoscopes have been increasingly applied in neurosurgery. Multiple exoscopic systems are available, all offering specific features. In this study, we assessed practical and visualization performance of four different exoscopic systems in a highly challenging microsurgical procedure, and evaluated whether these affected the quality of work. Methods: We included four different exoscopes: Olympus ORBEYE, Zeiss KINEVO, Storz VITOM, and Aesculap AEOS. With each exoscope, ten experimental bypass procedures were carried out on chicken wing vessels at a depth of 3 cm. We evaluated the quality of the anastomoses, the practical considerations for the setup of the exoscopic systems, and the visualization quality by tracking the number of unnecessary movements. Results: All included exoscopes enabled us to perform the bypass procedures with mostly adequate or excellent results. Surgically, the most pronounced difference between the exoscopes was the duration of the procedure, which was mainly due to the number of unnecessary movements. Practically, the exoscopes differ highly which is important when considering which exoscope to apply. Conclusions: This is the first study comparing different exoscope systems while performing the same challenging microsurgical procedure. We found major practical differences between the exoscopes that determine the suitability of an exoscope based on the demands and conditions of the surgical procedure. Therefore, preprocedural practical training with the exoscope is required.
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Affiliation(s)
- Ahmad Hafez
- Department of Neurosurgery, Helsinki University Hospital, P.O. Box 266, Fin-00029 Helsinki, Finland
- Correspondence: or ; Tel.: +358-405885513
| | - Roel Haeren
- Department of Neurosurgery, Maastricht University Medical Center, Postbus 5800, 6202 AZ Maastricht, The Netherlands
| | - Justiina Huhtakangas
- Department of Neurosurgery, Helsinki University Hospital, P.O. Box 266, Fin-00029 Helsinki, Finland
| | - Ville Nurminen
- Department of Neurosurgery, Helsinki University Hospital, P.O. Box 266, Fin-00029 Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, P.O. Box 266, Fin-00029 Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Hospital, P.O. Box 266, Fin-00029 Helsinki, Finland
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D’Andrea M, Musio A, Colasanti R, Mongardi L, Fuschillo D, Lofrese G, Tosatto L. A novel, reusable, realistic neurosurgical training simulator for cerebrovascular bypass surgery: Iatrotek ® bypass simulator validation study and literature review. Front Surg 2023; 10:1048083. [PMID: 36843992 PMCID: PMC9947354 DOI: 10.3389/fsurg.2023.1048083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
Background Microanastomosis is a challenging technique requiring continuous training to be mastered. Several models have been proposed, but few effectively reflect a real bypass surgery; even fewer are reusable, most are not easily accessible, and the setting is often quite long. We aim to validate a simplified, ready-to-use, reusable, ergonomic bypass simulator. Methods Twelve novice and two expert neurosurgeons completed eight End-to-End (EE), eight End-to-Side (ES), and eight Side-to-Side (SS) microanastomoses using 2-mm synthetic vessels. Data on time to perform bypass (TPB), number of sutures and time required to stop potential leaks were collected. After the last training, participants completed a Likert Like Survey for bypass simulator evaluation. Each participant was assessed using the Northwestern Objective Microanastomosis Assessment Tool (NOMAT). Results When comparing the first and last attempts, an improvement of the mean TPB was registered in both groups for the three types of microanastomosis. The improvement was always statistically significant in the novice group, while in the expert group, it was only significant for ES bypass. The NOMAT score improved in both groups, displaying statistical significance in the novices for EE bypass. The mean number of leakages, and the relative time for their resolution, also tended to progressively reduce in both groups by increasing the attempts. The Likert score expressed by the experts was slightly higher (25 vs. 24.58 by the novices). Conclusions Our proposed bypass training model may represent a simplified, ready-to-use, reusable, ergonomic, and efficient system to improve eye-hand coordination and dexterity in performing microanastomoses.
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Affiliation(s)
- Marcello D’Andrea
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
| | - Antonio Musio
- Department of Ferrara – Neurosurgery, Sant ‘Anna University Hospital, Ferrara, Italy,Correspondence: Antonio Musio
| | | | - Lorenzo Mongardi
- Department of Ferrara – Neurosurgery, Sant ‘Anna University Hospital, Ferrara, Italy
| | - Dalila Fuschillo
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
| | - Giorgio Lofrese
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
| | - Luigino Tosatto
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
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Lizana J, Montemurro N, Aliaga N, Marani W, Tanikawa R. From textbook to patient: a practical guide to train the end-to-side microvascular anastomosis. Br J Neurosurg 2023; 37:116-120. [PMID: 34092156 DOI: 10.1080/02688697.2021.1935732] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Microvascular anastomosis is one of the most challenging neurosurgical techniques. Mastering this technique allows to perform intracranial bypass with arteries of small caliber usually placed in deep narrow surgical fields. The aim of this paper is to describe step by step end-to-side microanastomosis training method by using polyvinyl alcohol (PVA) hydrogel tubing as it is easily reproducible. The tubing comes in sizes from 0.3 mm to 5 mm and has a texture and consistency similar to real vessels. This is based on the Teishinkai Hospital anastomosis technique. Continuous practice in microvascular anastomosis is of great importance in training vascular neurosurgeon. The PVA hydrogel tubing described in this article are useful and cost-effective material in the training of microvascular anastomosis. This practical guide model is easy to set up for repeated practice, and will contribute to facilitate 'off-the-job' training by young neurosurgeons and the development and maintenance of microsurgical skills in both resident neurosurgeons and experts who wish to master the various levels of anastomosis technique. There is no shortcut to master this technique, only hard work and perseverance.
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Affiliation(s)
- Jafeth Lizana
- Department of Neurosurgery, Hospital Nacional Guillermo Almenara, Lima, Perú.,Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Pisa, Italy
| | - Nelida Aliaga
- Medicine Faculty, Hospital Universidad Austral, Buenos Aires, Argentina
| | - Walter Marani
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan.,Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Pisa, Italy
| | - Rokuya Tanikawa
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
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Bypass Surgery Management of Complex Proximal and Distal Posterior Inferior Cerebellar Artery Aneurysms. J Craniofac Surg 2022; 33:2049-2054. [PMID: 35119411 DOI: 10.1097/scs.0000000000008507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/13/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND For the complex posterior inferior cerebellar artery (PICA) aneurysms, standard microsurgical or endovascular technical options were not feasible. To determine the efficacy and outcomes of bypass surgery for complex PICA aneurysms, the authors herein review our recent surgical experience for complex PICA aneurysms. METHODS The authors retrospectively reviewed our experience of extracranial-intracranial bypass and intracranial-intracranial bypass surgery in treatment of proximal and distal complex PICA aneurysms at our institution from 2016 to 2020. RESULTS Twelve patients harboring 12 complex PICA aneurysms received bypass surgery at our institution. Seven (58.3%) patients with proximal PICA aneurysms underwent extracranial-intracranial bypass. Five (41.7%) patients with distal PICA aneurysms accepted intracranial-intracranial bypass. The postoperative symptom improvement: Of the 6 patients with preoperative hypoperfusion or ischemic of the cerebellar hemisphere, the symptom resolved in 5 patients, improved in 1 patient, of 5 patients with preoperative mass effect, the symptom resolved in 5 patients. During the follow-up period, ten patients had a modified Rankin scale (mRS) score of 0 to 1, and 1 patient had an mRS score of 2. One patient had an mRS score of 3. The long-term graft patency rate was 91.7%. All patients had no recurrence of intracranial aneurysm. CONCLUSIONS Base on the complexity of anatomy structure and the vascular architecture, an individualized strategy was proposed for each patient. The use of different types of bypass procedures (occipital artery-PICA end-to-end bypass, PICA-PICA end-to-end anastomosis, and/or occipital artery graft) can safely and effectively manage these complex PICA aneurysms.
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Mehta SH, Belykh E, Farhadi DS, Preul MC, Kikuta KI. Needle Parking Interrupted Suturing Technique for Microvascular Anastomosis: A Technical Note. Oper Neurosurg (Hagerstown) 2021; 21:E414-E420. [PMID: 34424326 DOI: 10.1093/ons/opab280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Interrupted and continuous suturing are 2 common techniques for microvascular anastomosis in cerebrovascular surgery. One of the technical complexities of interrupted suturing includes the risk of losing the needle in between interrupted sutures during knot tying, which may result in unnecessary movements and wasted time. OBJECTIVE To report a new needle parking technique for microvascular anastomosis that addresses a needle control problem during interrupted suturing. METHODS The needle parking technique involves puncturing both vessel walls at the site of the next provisional suture and leaving the needle parked in place while the knots at the first suture are being made. The thread is then cut, the needle is pulled through, and the process is repeated. Illustrative cases in which the needle parking technique was used are presented. We also compared time of anastomosis completion between the conventional interrupted, needle parking interrupted, and continuous suturing techniques during an in vitro study on standardized artificial vessels. RESULTS This technique is being used successfully by the senior author for various cerebrovascular bypass surgeries. The in vitro study demonstrated that the needle parking technique can be significantly faster than the conventional interrupted suturing technique and may be as fast as continuous suturing. CONCLUSION Needle parking technique is a modification of conventional interrupted suturing and solves the problem of losing the needle during knot tying. This technique is simple, prevents unnecessary movements, and may result in a faster anastomosis time.
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Affiliation(s)
- Shyle H Mehta
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Evgenii Belykh
- Department of Neurological Surgery, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Dara S Farhadi
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mark C Preul
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Abstract
BACKGROUND With the development of bypass technique, more and more complex aneurysms can be treated with bypass surgery. The goal of this study is to evaluate the efficacy and safety of bypass in patients with giant cavernous carotid aneurysms (GCCAs). To further discuss the treatment of asymptomatic GCCAs. METHODS The authors retrospectively reviewed our experience of the internal carotid artery (ICA) ligation/constriction combined with high/low-flow bypass surgery in the treatment of GCCAs. RESULTS Among the entire cohort, 4 patients underwent ICA ligation combined with high-flow bypass, 7 patients underwent ICA ligation/constriction combined with low-flow bypass. The postoperative symptom improvement: of 9 patients with preoperative ophthalmoplegia, the symptom resolved in 2 patients, improved in 7 patients, of 7 patients with preoperative pain, the symptom resolved in 2 patients, improved in 4 patients and was unchanged in 1 patient. The results of following-up were measured using the modified Rankin scale (mRS). During the follow-up, there were 9 patients with mRS score 0 to 1, 1 patient with mRS score 2, and 1 patient with mRS score 3. The long-term graft patency rate was 100%. All patients had no recurrence of intracranial aneurysm. CONCLUSIONS Bypass surgery is a safe and effective method to treat GCCAs. Because of the risk of GCCAs and the improvement of bypass surgery technology, active surgical strategies should be adopted for asymptomatic or mild symptomatic GCCAs.
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Keser N, Elshamy W, Chen X, Velioglu M, Is M, Xu Y, Eroksuz M, Ermutlu I, Huryol C, Jian R, Ates O. Challenges in Using the Posterior Inferior Cerebellar Artery for Revascularization of the Anterior Inferior Cerebellar Artery: A Microsurgical Anatomic Study. World Neurosurg 2021; 150:e591-e599. [PMID: 33753318 DOI: 10.1016/j.wneu.2021.03.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND A bypass is usually required to prevent ischemia during the treatment of anterior inferior cerebellar artery (AICA) aneurysms. The intracranial (IC)-to-IC bypass provides several advantages over the extracranial-to-IC bypass in the posterior fossa. However, there are only 2 case reports about AICA revascularization with the posterior inferior cerebellar artery (PICA). We aimed to investigate the microsurgical anatomical challenges for PICA to AICA anastomosis. METHODS Ten cadaveric heads injected with colored silicone were inspected on both sides using a lateral transcondylar approach. After the donor and recipient arteries were examined from the posterior side, neurovascular contents of the posterior fossa were excised and the origin, course, and variations of both arteries were investigated from the anterior view. The diameters of the AICA and PICA segments and the intersegment distance were measured. RESULTS PICA variations and posteromedial origins from the vertebral artery were identified in 8 of the 20 right and 6 of the 20 left sides, and the first segment of the PICA was not present in 7 sides. Furthermore, in 18 sides, the PICA was trapped between the lower cranial nerves and dentate ligaments. Therefore the donor artery could not be brought closer than 1 cm to the recipient artery in 19 sides. Moreover, AICA variations were identified in 6 sides, and in 12 sides, the diameter of the recipient artery was <1 mm. CONCLUSIONS The mostly PICA-related issues made PICA-to-AICA anastomosis unfeasible in all cadaveric heads included in the study.
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Affiliation(s)
- Nese Keser
- Department of Neurosurgery, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - Walid Elshamy
- Ain Shams University Faculty of Medicine, Department of Neurosurgery, Cairo, Egypt
| | - Xinpu Chen
- Zhengzhou University School of Medicine, Department of Neurosurgery, Zhengzhou, China
| | - Murat Velioglu
- Department of Radiology, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Merih Is
- Retired Neurosurgeon, Department of Neurosurgery, University of Health Sciences, Istanbul, Turkey
| | - Yinfu Xu
- The Second People's Hospital of Liaocheng Shandong University, Department of Neurosurgery, Liaocheng Shandong, China
| | - Melih Eroksuz
- Marmara University School of Medicine, Institute of Neurological Sciences, Department of Neurosurgery, Istanbul, Turkey
| | - Ilcim Ermutlu
- Department of Neurosurgery, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Cagin Huryol
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Ruan Jian
- Chongqing University Cancer Hospital, Department of Neurosurgery, Chongqing, China
| | - Ozkan Ates
- Koc University School of Medicine Hospital, Department of Neurosurgery, Istanbul, Turkey
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Hafez A, Haeren RHL, Dillmann J, Laakso A, Niemelä M, Lehecka M. Comparison of Operating Microscope and Exoscope in a Highly Challenging Experimental Setting. World Neurosurg 2020; 147:e468-e475. [PMID: 33385603 DOI: 10.1016/j.wneu.2020.12.093] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of a digital three-dimensional (3D) exoscope system in neurosurgery is increasing as an alternative to the operative microscope. The objective of this study was to compare a digital 3D exoscope system with a standard operating microscope as a neurosurgical visualization tool in a highly challenging experimental setting. METHODS End-to-side bypass procedures, each at a depth of 9 cm, were performed in a simulation setting. The quality of the task and the depth effect, visualization, magnification, illumination, and ergonomics were evaluated. RESULTS No major differences were noted between the microscope and the 3D exoscope in terms of the quality of the work. Working with the 3D exoscope was more time-consuming than working with the microscope. Changing the depth and focus was faster using the operative microscope. The 3D exoscope enabled higher magnification and offered better ergonomic features. CONCLUSIONS In a highly challenging experimental setting, comparable procedural quality was found for the microscope and the 3D exoscope. Each visualization tool had advantages and disadvantages. Over time and with technologic advances, the digital 3D exoscope may become the main operative visualization system in microneurosurgery.
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Affiliation(s)
- Ahmad Hafez
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
| | - Roel H L Haeren
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland; Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Johannes Dillmann
- Department of Neurosurgery, Diakonieklinikum Jung-Stilling, Siegen, Germany
| | - Aki Laakso
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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Hafez A, Elsharkawy A, Schwartz C, Muhammad S, Laakso A, Niemelä M, Lehecka M. Comparison of Conventional Microscopic and Exoscopic Experimental Bypass Anastomosis: A Technical Analysis. World Neurosurg 2019; 135:e293-e299. [PMID: 31805406 DOI: 10.1016/j.wneu.2019.11.154] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recently, the use of digital exoscopes has been increasingly promoted as an alternative to microscopes. The aim of this study is to compare experimental bypass quality in both visualization methods. METHODS This study used two hundred 1-mm chicken wing vessels, which were used for either exoscopic or microscopic (100 samples each) bypass procedures. All procedures were recorded between July 2018 and September 2018. The bypass quality was evaluated according to our published practical scale (time, stitch distribution, intima-intima attachment, and orifice size). RESULTS Both methods are effective in doing bypass suturing (practical scale score was good, 86% vs. 85%; P = 0.84). There were no significant differences regarding intima-intima attachment (P = 0.26) and orifice size (P = 0.25). However, suturing time (P < 0.001) was less using the microscope, whereas stitch distribution (P = 0.001) was better using the exoscope. Different suturing techniques (interrupted vs. continuous) had overall comparable results (P = 0.55). CONCLUSIONS Both methods produced equally satisfactory results in experimental bypass procedures. The exoscope has the potential for better 3-dimensional visualization and sharing the surgeon's view with others for teaching purposes.
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Affiliation(s)
- Ahmad Hafez
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
| | - Ahmed Elsharkawy
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Tanta University, Tanta, Egypt
| | - Christoph Schwartz
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Paracelsus Medical University, Salzburg, Austria
| | - Sajjad Muhammad
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Aki Laakso
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
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Meditation music improved the quality of suturing in an experimental bypass procedure. Acta Neurochir (Wien) 2019; 161:1515-1521. [PMID: 31227967 DOI: 10.1007/s00701-019-03976-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 06/05/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neurosurgeons are vulnerable to additional noise in their natural operating environment. Noise exposure is associated with reduced cognitive function, inability to concentrate, and nervousness. Mediation music provides an opportunity to create a calmer environment which may reduce stress during surgery. METHODS A pilot study was performed to find a suitable task, meditation music of surgeon's choice, and operation noise and to reach a certain level of training. For the main experiment, two neurosurgeons with different microsurgical experience used real operation noise and meditation music with delta waves as mediating music. Each surgeon performed 10 training bypasses (five with noise and five with music) with 16 stitches in each bypass. The total time to complete 16 stitches, a number of unachieved movements (N.U.Ms), length of thread consumed, and distribution of the stitches were quantified from the recorded videos and compared in both groups. RESULTS A N.U.Ms were significantly reduced from 109 ± 38 with operation room (OR) noise to 38 ± 13 (p < 0.05) with meditating music in novice surgeon. Similar results were found in the experienced surgeon performing the same task [from 29 ± 6.94 to 14 ± 3.36 (p < 0.05)]. The total time utilized for the sixteen stitches was slightly improved (not significantly) in the novice surgeon and unchanged in the experienced surgeon. However, the thread length used for 16 stitches was significantly different with OR noise in comparison to meditating music in both surgeons. The distribution stitches showed a non-significant trend toward a uniform distribution with meditation music in both surgeons. CONCLUSIONS Meditation music of surgeon's choice is a simple method that improved quality of bypass suturing in an experimental bypass procedure.
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