The use of non-living animals as simulation models for cranial neurosurgical procedures: a literature review

Surgical Aortic Valve Replacement Using a Porcine Model: A Low-Cost Simulation for Surgical Trainees

Simulation experiences are valuable to the training of future successful surgeons. These experiences introduce trainees to operational concepts through hands-on engagement within a low-stress environment to promote skill, information retention, and increased competency for future success in real-life scenarios. The study aimed to develop a low-cost, reproducible surgical simulation for teaching aortic valve replacement using porcine models. This study employed a single-center educational workshop design to provide trainees with a comprehensive wet laboratory experience in surgical aortic valve replacement using a porcine model. The simulation involved step-by-step procedures using porcine hearts in a wet lab environment, emphasizing specific surgical techniques such as suturing, knot tying, and valve replacement. Simulated valves were created using insulation foaming and aluminum wiring. The study was conducted at a southeastern medical school's wet lab. Thirty-eight preclinical medical students participated. The simulation was designed to provide a comprehensive overview of the steps involved in aortic valve replacement using porcine models. It emphasized the importance of teamwork, fundamental surgical skills, and effective communication within a surgical setting. The low-cost surgical simulation allowed trainees to learn technical skills that could be tailored to their proficiency level. Simulation for cardiothoracic procedures is limited by monetary spending and the availability of adequate materials to create a beneficial learning experience. This low-cost simulation allows resource-limited institutions to provide their students an additional opportunity to practice fundamental surgical principles such as suturing.

Evaluation of 3D Printed Burr Hole Simulation Models Using 8 Different Materials

OBJECTIVE

3D printing is increasingly used to fabricate three-dimensional neurosurgical simulation models, making training more accessible and economical. 3D printing includes various technologies with different capabilities for reproducing human anatomy. This study evaluated different materials across a broad range of 3D printing technologies to identify the combination that most precisely represents the parietal region of the skull for burr hole simulation.

METHODS

Eight different materials (polyethylene terephthalate glycol, Tough PLA, FibreTuff, White Resin, BoneSTN, SkullSTN, polymide [PA12], glass-filled polyamide [PA12-GF]) across 4 different 3D printing processes (fused filament fabrication, stereolithography, material jetting, selective laser sintering) were produced as skull samples that fit into a larger head model derived from computed tomography imaging. Five neurosurgeons conducted burr holes on each sample while blinded to the details of manufacturing method and cost. Qualities of mechanical drilling, visual appearance, skull exterior, and skull interior (i.e., diploë) and overall opinion were documented, and a final ranking activity was performed along with a semistructured interview.

RESULTS

The study found that 3D printed polyethylene terephthalate glycol (using fused filament fabrication) and White Resin (using stereolithography) were the best models to replicate the skull, surpassing advanced multimaterial samples from a Stratasys J750 Digital Anatomy Printer. The interior (e.g., infill) and exterior structures strongly influenced the overall ranking of samples. All neurosurgeons agreed that practical simulation with 3D printed models can play a vital role in neurosurgical training.

CONCLUSIONS

The study findings reveal that widely accessible desktop 3D printers and materials can play a valuable role in neurosurgical training.

Cadaveric Sheep Head Model for Anterior Clinoidectomy in Neurosurgical Training

BACKGROUND

Anterior clinoidectomy is an important procedure used in the treatment of a range of diseases of the frontotemporal region, both vascular and tumoral. Mastering this technique requires a high level of manual skills training. The objective of the study was to describe an easily accessible and economical alternative model of anterior clinoidectomy, with a principal focus on the significance of mastering technical skills and training tactile feedback.

METHODS

Five cadaveric sheep heads (10 sides) fixed in formalin and alcohol were injected with silicone and used to simulate extradural (5 sides) and intradural (5 sides) routes and 1 head was used to prepare an anatomic specimen for better demonstration of the anatomy of the paraclinoid region.

RESULTS

A comparative anatomic analysis between the ovine and human anterior clinoid process was performed. Using cadaveric sheep models, all principal steps of the procedure for both the extradural and the intradural routes were imitated.

CONCLUSIONS

A cadaveric sheep head model serves as a good model of anterior clinoidectomy regarding manual skills training and can serve as a good alternative to human cadaveric training.

Academic productivity of Iraqi medical students in the field of neurosurgery: A literature review

Background

The interest in clinical research is growing worldwide, and the involvement of medical students in academic and clinical research is increasing. Medical students in Iraq have started to focus on academic activities. However, this trend is in its infancy due to limited resources and the war burden. Their interest in the field of Neurosurgery has been evolving recently. This is the first paper that aims to assess the status of the academic productivity of Iraqi medical students within the neurosurgical field.

Methods

We searched the PubMed Medline database and Google scholar between January 2020 and December 2022 with a different combination of keywords. Additional results were obtained by individually searching for all the medical universities in Iraq that participated in the neurosurgical literature.

Results

Between January 2020 and December 2022, 60 neurosurgical publications included Iraqi medical students. 47 Iraqi medical students from 9 universities (the University of Baghdad 28 students, followed by 6 students from the University of Al-Nahrain, and others) were involved in these 60 neurosurgery publications. The topics of these publications are "vascular neurosurgery" (n = 36) followed by "neurotrauma" (n = 11).

Conclusion

Academic productivity of Iraqi medical students in the field of Neurosurgery has surged in the last 3 years. In the past 3 years, 47 Iraqi medical students from nine different Iraqi universities contributed to sixty international neurosurgical publications. However, there are challenges that are required to be tackled to establish a research-friendly environment despite wars and restrained resources.

Properties and Characteristics of Three-Dimensional Printed Head Models Used in Simulation of Neurosurgical Procedures: A Scoping Review

BACKGROUND

Intracranial surgery can be complex and high risk. Safety, ethical and financial factors make training in the area challenging. Head model 3-dimensional (3D) printing is a realistic training alternative to patient and traditional means of cadaver and animal model simulation.

OBJECTIVE

To describe important factors relating to the 3D printing of human head models and how such models perform as simulators.

METHODS

Searches were performed in PubMed, the Cochrane Library, Scopus, and Web of Science. Articles were screened independently by 3 reviewers using Covidence software. Data items were collected under 5 categories: study information; printers and processes; head model specifics; simulation and evaluations; and costs and production times.

RESULTS

Forty articles published over the last 10 years were included in the review. A range of printers, printing methods, and substrates were used to create head models and tissue types. Complexity of the models ranged from sections of single tissue type (e.g., bone) to high-fidelity integration of multiple tissue types. Some models incorporated disease (e.g., tumors and aneurysms) and artificial physiology (e.g., pulsatile circulation). Aneurysm clipping, bone drilling, craniotomy, endonasal surgery, and tumor resection were the most commonly practiced procedures. Evaluations completed by those using the models were generally favorable.

CONCLUSIONS

The findings of this review indicate that those who practice surgery and surgical techniques on 3D-printed head models deem them to be valuable assets in cranial surgery training. Understanding how surgical simulation on such models affects surgical performance and patient outcomes, and considering cost-effectiveness, are important future research endeavors.

PubMed-indexed neurosurgical research productivity of Iraq-based neurosurgeons

Background:

Research is a central component of neurosurgical training and practice and is increasingly viewed as a quintessential indicator of academic productivity. In this study, we focus on identifying the current status and challenges of neurosurgical research in Iraq.

Methods:

An online PubMed Medline database search was conducted to identify all articles published by Iraq-based neurosurgeons between 2003 and 2020. Information was extracted in relation to the following parameters: authors, year of publication, author’s affiliation, author’s specialty, article type, article citation, journal name, journal impact factor, and topic. This data were then tabulated and analyzed.

Results:

Between 2003 and 2021, a total of 52 PubMed indexed papers were published from Iraq. All publications have been clustered in the period of 2012–2020. From 2012 to 2016, only four papers were published, one per year. The number of publications increased from 2017 to 2021, with an average of 12 publications per year. The most common article type was “case reports” (n = 14). Neurotrauma (n = 10) and vascular neurosurgery (n = 10) were the two most common topics. Most of the studies came from the city of Bagdad (n = 46), with just nine studies coming from peripheral governorates. The Neurosurgery Teaching Hospital in Bagdad was the neurosurgery center with the highest research output (n = 38).

Conclusion:

The number of publications per year has been showing a, relatively, promising trend since 2012. However, to promote sustained growth in academic productivity, a strategic plan that acknowledges the political, financial, and health-system-related challenges are urgently needed.