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Santori AM, Arancibia MS, Andaluz N. Fresh Cadaver Simulation Model with Continuous Extracorporeal Circulation as a Training Platform for Intracranial High-Flow Bypass: Technical Note and Rheologic Feasibility Evaluation. Skull Base Surg 2022; 83:e367-e373. [DOI: 10.1055/s-0041-1729179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
Abstract
Abstract
Introduction As endovascular techniques evolve toward replacing open surgery, several clinical scenarios still require surgical revascularization. Characterizing this era are decreasing surgical volumes and lack of realistic training models. In an effort to develop lifelike simulation models, we developed a platform for surgical training on high-flow bypass in a fresh cadaver model. Our technique incorporated an extracorporeal circulating system that resembled clinical conditions and confirmed anastomosis efficacy by clinical parameters.
Methods On three fresh cadaveric heads, the subtemporal approach exposed the petrous internal carotid artery (ICA) (C2) as the donor vessel for an interposition radial artery graft. Using a continuous extracorporeal circulation system, the bypass model was tested in three fresh heads and verified using clinical technologies.
Results Successful C2 ICA to M2 anastomosis was completed in all three fresh heads, confirmed with qualitative and quantitative Doppler, and indocyanine green angiography. Antegrade distribution through graft and revascularized territory was documented on postoperative computed tomography (CT) scan with radiopaque silicone injected through the ipsilateral carotid.
Conclusion This study confirmed the feasibility of a totally intracranial high-flow bypass in a fresh cadaver model that achieved hemodynamic features aligned with those of normal middle cerebral artery flow in the clinical setting.
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Affiliation(s)
- Alejandro Mercado Santori
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Servicio de Neurocirugía, Hospital Militar Regional Mendoza, Mendoza, Argentina
| | - María Sol Arancibia
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Servicio de Neurocirugía, Hospital Militar Regional Mendoza, Mendoza, Argentina
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Comprehensive Stroke Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, United States
- Mayfield Clinic, Cincinnati, Ohio, United States
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Tawfik-Helika M, Mertens P, Ribas G, Cusimano MD, Catala M, Kirollos R, Jacquesson T. Understanding Anatomy of the Petrous Pyramid-A New Compartmental Approach. World Neurosurg 2019; 124:e65-e80. [PMID: 30620892 DOI: 10.1016/j.wneu.2018.11.234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/24/2018] [Accepted: 11/26/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Learning surgical anatomy of the petrous pyramid can be a challenge, especially in the beginning of the training process. Providing an easier, holistic approach can be of help to everyone with interest in learning and teaching skull base anatomy. We present the complex organization of petrous pyramid anatomy using a new compartmental approach that is simple to understand and remember. METHODS The surfaces of the petrous pyramid of two temporal bones were examined; and the contents of the petrous pyramid of 8 temporal bones were exposed through progressive drilling of the superior surface. RESULTS The petrous pyramid is made up of a bony container, and its contents were grouped into 4 compartments (mucosal, cutaneous, neural, and vascular). Two reference lines were identified (mucosal and external-internal auditory canal lines) intersecting at the level of the middle ear. The localization of contents relative to these reference lines was then described, and 2 methods of segmentation (the X method and the V method) were then proposed. This description was then used to describe middle ear relationships, facial nerve anatomy, and air cell distribution. CONCLUSIONS This new compartmental approach allows a comprehensive understanding of the distribution of petrous pyramid contents. Dividing it into anatomic compartments, and then navigating this mental map along specific reference points, lines, spaces, and segments, could create a useful tool to teach or learn its complex tridimensional anatomy.
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Affiliation(s)
- Mamdouh Tawfik-Helika
- Department of Neurosurgery, Beaujon University Hospital, Assistance publique hopitaux de Paris, Clichy, France.
| | | | - Guilherme Ribas
- Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Michael D Cusimano
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Martin Catala
- Sorbonne Université, CNRS UMR 7622, INSERM ERL 1156, IBPS, Paris, France
| | - Ramez Kirollos
- Senior Consultant, National Neuroscience Institute, Singapore
| | - Timothée Jacquesson
- Department of Anatomy, University of Lyon 1, Lyon, France; Skull Base Multi-disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon Cedex, France
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Belykh E, Lei T, Safavi-Abbasi S, Yagmurlu K, Almefty RO, Sun H, Almefty KK, Belykh O, Byvaltsev VA, Spetzler RF, Nakaji P, Preul MC. Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study. J Neurosurg 2016; 125:915-928. [DOI: 10.3171/2015.8.jns151346] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE
Microvascular anastomosis is a basic neurosurgical technique that should be mastered in the laboratory. Human and bovine placentas have been proposed as convenient surgical practice models; however, the histologic characteristics of these tissues have not been compared with human cerebral vessels, and the models have not been validated as simulation training models. In this study, the authors assessed the construct, face, and content validities of microvascular bypass simulation models that used human and bovine placental vessels.
METHODS
The characteristics of vessel segments from 30 human and 10 bovine placentas were assessed anatomically and histologically. Microvascular bypasses were performed on the placenta models according to a delineated training module by “trained” participants (10 practicing neurosurgeons and 7 residents with microsurgical experience) and “untrained” participants (10 medical students and 3 residents without experience). Anastomosis performance and impressions of the model were assessed using the Northwestern Objective Microanastomosis Assessment Tool (NOMAT) scale and a posttraining survey.
RESULTS
Human placental arteries were found to approximate the M2–M4 cerebral and superficial temporal arteries, and bovine placental veins were found to approximate the internal carotid and radial arteries. The mean NOMAT performance score was 37.2 ± 7.0 in the untrained group versus 62.7 ± 6.1 in the trained group (p < 0.01; construct validity). A 50% probability of allocation to either group corresponded to 50 NOMAT points. In the posttraining survey, 16 of 17 of the trained participants (94%) scored the model's replication of real bypass surgery as high, and 16 of 17 (94%) scored the difficulty as “the same” (face validity). All participants, 30 of 30 (100%), answered positively to questions regarding the ability of the model to improve microsurgical technique (content validity).
CONCLUSIONS
Human placental arteries and bovine placental veins are convenient, anatomically relevant, and beneficial models for microneurosurgical training. Microanastomosis simulation using these models has high face, content, and construct validities. A NOMAT score of more than 50 indicated successful performance of the microanastomosis tasks.
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Affiliation(s)
- Evgenii Belykh
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
- 2Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology; and
| | - Ting Lei
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Sam Safavi-Abbasi
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaan Yagmurlu
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Rami O. Almefty
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Hai Sun
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaith K. Almefty
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Olga Belykh
- 3Irkutsk State Medical University, Irkutsk, Russia
| | - Vadim A. Byvaltsev
- 2Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology; and
- 3Irkutsk State Medical University, Irkutsk, Russia
| | - Robert F. Spetzler
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C. Preul
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Colasanti R, Tailor ARA, Lamki T, Zhang J, Ammirati M. Maximizing the Petroclival Region Exposure Via a Suboccipital Retrosigmoid Approach: Where Is the Intrapetrous Internal Carotid Artery? Oper Neurosurg (Hagerstown) 2015; 11 Suppl 2:329-36; discussion 336-7. [DOI: 10.1227/neu.0000000000000749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractBACKGROUNDRecent reports have validated the use of retrosigmoid approach extensions to deal with petroclival lesions.OBJECTIVETo describe the topographic retrosigmoid anatomy of the intrapetrous internal carotid artery (IICA), providing guidelines for maximizing the petroclival region exposure via this route.METHODSThe IICA was exposed bilaterally in 6 specimens via a retrosigmoid approach in the semisitting position. Its topographic relationship with pertinent posterolateral cranial base landmarks was quantified with neuronavigation.RESULTSSafe exposure of the IICA and the surrounding inframeatal/petroclival regions was accomplished in all specimens. On average, the IICA genu was 15.08 mm anterolateral to the XI nerve in the jugular foramen, 16.18 mm anteroinferolateral to the endolymphatic sac, and 10.63 mm anteroinferolateral to the internal acoustic meatus. On average, the IICA horizontal segment was 9.92 mm inferolateral to the Meckel cave, and its midpoint was 19.96 mm anterolateral to the XI nerve in the jugular foramen. The mean distance from the IICA genu to the cochlea was 1.96 mm. The genu and the midpoint of the horizontal segment of the IICA were exposed at a depth of approximately 14.50 mm from the posterior pyramidal wall with the use of different drilling angles (49.74° vs 39.54°, respectively).CONCLUSIONKnowledge of the IICA general relationship with these landmarks (combined with a careful assessment of the preoperative imaging and with the use of intraoperative navigation and micro-Doppler) may help to enhance the inframeatal/petroclival region exposure via a retrosigmoid route, maximizing safe inframeatal and suprameatal petrous bone removal while minimizing neurovascular complications.
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Affiliation(s)
- Roberto Colasanti
- Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
- Department of Radiology and Wright Center of Innovation in Biomedical Imaging, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Al-Rahim A Tailor
- Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Tariq Lamki
- Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jun Zhang
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Mario Ammirati
- Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
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