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Nas E, Nteli Chatzioglou G, Gayretli Ö. Anatomical evaluation of P1 segment of posterior cerebral artery and posterior communicanting artery in 340 human hemispheres: a proposal for morphological classification. Surg Radiol Anat 2024; 46:685-695. [PMID: 38489065 DOI: 10.1007/s00276-024-03335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE The aim of our study is to examine the morphometry of the P1 segment of the posterior cerebral artery (P1) and the posterior communicating artery (PcomA) and to present a descriptive classification according to morphometric findings. METHODS 340 hemispheres from 170 cadavers were included. The outer diameters of P1 and PcomA were measured with ImageJ software. Then, the configurations of the posterior cerebral artery were revealed as fetal, adult and transitional. The findings were correlated with the demographic information of the cadavers such as gender, body mass index (BMI), age. RESULTS According to the morphometric findings, 83.75%, 13.85% and 2.40% of the posterior cerebral arteries were found to be adult, fetal and transitional, respectively. The fetal type was more common in cadavers aged 60 years and older (13.73%) compared to the 18-39 and 40-59 age groups. In addition, P1 and PcomA diameters also increased with age. Fetal and transtional types showed a similar low distribution in people with low (< 18.5), normal (18.5-24.9), overweight (25-29.9) and obese (> 30) BMI, whereas adult type was found in cadavers with a normal BMI of 140/303. CONCLUSION We believe that the findings of our study will contribute to the planning of neurointerventional procedures, the development of endovascular devices, the success of invasive procedures and the reduction of complications.
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Affiliation(s)
- Emine Nas
- Department of Anatomy, Faculty of Medicine, Istanbul Health and Technology University, Istanbul, Turkey
- Department of Anatomy, Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Turkey
| | - Gkionoul Nteli Chatzioglou
- Departement of Anatomy, Faculty of Medicine, Istanbul Health and Technology University, Istanbul, Turkey.
| | - Özcan Gayretli
- Department of Anatomy, Faculty of Medicine, Istanbul Health and Technology University, Istanbul, Turkey
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Nas E, Nteli Chatzioglou G, Şahan O, Kale A, Dolaş İ, Çakır H, Coşkun O, Gayretli Ö. Anatomical Features of Posterior Cerebral Arteries and Basilar Artery in 170 Anatolian Fresh Cadavers: Implications for Surgical Planning and Intervention. World Neurosurg 2024; 184:e255-e265. [PMID: 38278211 DOI: 10.1016/j.wneu.2024.01.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND The posterior cerebral arteries (PCAs) are terminal branches of the basilar artery (BA) and are responsible for the primary supply of the occipital lobe. Saccular aneurysm is most commonly seen close to the bifurcation of the BA. Various surgical interventions are performed for aneurysms. Therefore, the anatomy and localization of the BA and PCA are crucial. The aim of this study was to determine the characteristics of these arteries in a large Anatolian population. METHODS The study included 170 Anatolian fresh cadavers. The diameters of the BA and PCA were measured. Correlations according to sex and age groups were analyzed. The Q1, Q2, and Q3 angles between the right and left PCA, between the right PCA and BA, and between the left PCA and BA, respectively, were measured. The location of the PCA relative to the sulcus pontocruralis (pontocrural groove) was also evaluated. RESULTS The diameter of the artery increased with age and was higher in males than in females. Q1 and Q2 diameters were larger in males, while the Q3 diameter was larger in females. The Q1 angle between the right and left PCAs was found to be higher in age range 40-59 years with a mean of 87.33 ± 17.91 mm. Finally, the bifurcation point of the PCA was most frequently located above the sulcus pontocruralis (pontocrural groove) and least frequently located on the sulcus pontocruralis (pontocrural groove). CONCLUSIONS The findings of our study will contribute to the planning of surgical approaches, the development of endovascular devices, the success of invasive procedures, and the reduction of complications.
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Affiliation(s)
- Emine Nas
- Department of Anatomy, Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Gkionoul Nteli Chatzioglou
- Department of Anatomy, Faculty of Medicine, Istanbul Health and Technology University, Istanbul, Türkiye.
| | - Orhun Şahan
- Department of Morgue, Council of Forensic Medicine, Istanbul, Türkiye
| | - Ayşin Kale
- Department of Anatomy, Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - İlyas Dolaş
- Department of Neurosurgery, Istanbul University, Istanbul, Türkiye
| | - Halit Çakır
- Department of Morgue, Council of Forensic Medicine, Istanbul, Türkiye
| | - Osman Coşkun
- Department of Anatomy, Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Özcan Gayretli
- Department of Anatomy, Faculty of Medicine, Istanbul University, Istanbul, Türkiye
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Maurya I, Ahmed SM, Garg R. Simulation in airway management teaching and training. Indian J Anaesth 2024; 68:52-57. [PMID: 38406347 PMCID: PMC10893796 DOI: 10.4103/ija.ija_1234_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/25/2023] [Accepted: 12/31/2023] [Indexed: 02/27/2024] Open
Abstract
There is a gradual shift in training and teaching methods in the medical field. We are slowly moving from the traditional model and adopting active learning methods like simulation-based training. Airway management is an essential clinical skill for any anaesthesiologist, and a trained anaesthesiologist must perform quick and definitive airway management using various techniques. Airway simulations have been used for the past few decades. It ensures active involvement, upgrading the trainees' airway management knowledge and skills, including basic airway skills, invasive procedures, and difficult clinical scenarios. Trainees also learn non-technical skills such as communication, teamwork, and coordination. A wide range of airway simulators are available. However, texture surface characteristics vary from one type to another. The simulation-based airway management training requires availability, understanding, faculty development, and a structured curriculum for effective delivery. This article explored the available evidence on simulation-based airway management teaching and training.
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Affiliation(s)
- Indubala Maurya
- Department of Anaesthesiology, Kalyan Singh Super Specialty Cancer Institute, Lucknow, Uttar Pradesh, India
| | - Syed M. Ahmed
- Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia, Pain and Palliative Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Formalin-free soft embalming of human cadavers using N-vinyl-2-pyrrolidone: perspectives for cadaver surgical training and medical device development. Anat Sci Int 2022; 97:273-282. [PMID: 35460067 DOI: 10.1007/s12565-022-00664-9] [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: 01/07/2022] [Accepted: 03/30/2022] [Indexed: 02/05/2023]
Abstract
The traditional apprenticeship approach to surgical skill education for young surgeons has drastically changed to more systematic surgical training using cadavers. Cadavers fixed with formalin are not suitable for surgical training because of their associated health hazards and overhardening. Recently, we established a formalin-free soft preservation method for human cadavers using N-vinyl-2-pyrrolidone. Since 2012, 61 cadavers have been embalmed with pyrrolidone in our institution. Tissues of pyrrolidone-embalmed cadavers are soft and pliable, and their bodies can be preserved for as long as 37 months without any signs of corruption. In this review, we introduce our recent attempts to apply pyrrolidone-embalmed cadavers in surgical and medical procedure training, including endotracheal intubation, motion physiology of the vocal folds, laparoscopic surgery, endoscopic skull base surgery, and development of novel medical devices. Future research perspectives on pyrrolidone embalming are discussed.
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Chandran R, Koo SH, Lim YY, Ramadorai A, Tan AKL, Singh PA, Negar A, Lai JB. Enhanced Experiential Learning in Airway Management: Surgical Modification of Cadavers. Simul Healthc 2021; 16:142-150. [PMID: 32890317 DOI: 10.1097/sih.0000000000000488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Failure of airway management remains a significant source of morbidity and mortality. Advanced airway management has been addressed effectively by simulation-based training. However, simulation of difficult airways in manikins is limited by the pre-set conditions provided by the manufacturer. Life-like conditions in the form of the softness of the tissue and true anatomy as seen in cadaver models are needed to create simulated models with a closer resemblance to real patients. The goal of this study was to determine the feasibility of simulating difficult airway from submandibular abscess in cadaver models by surgical modification of the cadaver heads for use in enhanced experiential learning of the management of difficult airways. METHODS The cadaver heads were modified surgically to simulate a submandibular abscess. The models were used in an airway course where participants provided feedback on the realistic nature of the model and its benefits for difficult airway training. The ease of tracheal intubation of the models with the assistance of video laryngoscopy was assessed. RESULTS The modified cadavers were acceptable in simulating difficult airway as demonstrated by the feedback from the participants. All participants (100% [95% confidence interval = 89.1%-100%]) found the models to be realistic and beneficial for difficult airway training. A good proportion (56.3%) felt that the intubation technique was made easier with the video laryngoscopy. CONCLUSIONS Cadavers can be modified to simulate pathologies associated with difficult airways. These models can be used to enhance experiential learning and the management of difficult airways.
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Affiliation(s)
- Rajkumar Chandran
- From the Department of Anesthesia and Surgical Intensive Care (R.C., P.A.S., A.N.), Clinical Trials & Research Unit (S.H.K.), Department of Oral & Maxillofacial Surgery (A.R., J.B.L.), Department of Otorhinolaryngology, Head and Neck Surgery (A.K.L.T.), Changi General Hospital; and Ministry of Health Holdings (Y.Y.L.), Singapore
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Koopman EM, van Emden MW, Geurts JJ, Schwarte LA, Schober P. Comparison of videolaryngoscopy alone with video-assisted fibreoptic intubation in a difficult cadaver airway model. Eur J Anaesthesiol 2021; 38:318-319. [PMID: 33538435 PMCID: PMC7932750 DOI: 10.1097/eja.0000000000001333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT No Abstract.
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van Emden MW, Geurts JJG, Schober P, Schwarte LA. Suitability and realism of the novel Fix for Life cadaver model for videolaryngoscopy and fibreoptic tracheoscopy in airway management training. BMC Anesthesiol 2020; 20:203. [PMID: 32799813 PMCID: PMC7429731 DOI: 10.1186/s12871-020-01121-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/06/2020] [Indexed: 11/13/2022] Open
Abstract
Background Videolaryngoscopy is increasingly advocated as the standard intubation technique, while fibreoptic intubation is broadly regarded as the ‘gold standard’ for difficult airways. Traditionally, the training of these techniques is on patients, though manikins, simulators and cadavers are also used, with their respective limitations. In this study, we investigated whether the novel ‘Fix for Life’ (F4L) cadaver model is a suitable and realistic model for the teaching of these two intubation techniques to novices in airway management. Methods Forty consultant anaesthetists and senior trainees were instructed to perform tracheal intubation with videolaryngoscopy and fibreoptic tracheoscopy in four F4L cadaver models. The primary outcome measure was the verbal rating scores (scale 1–10, higher scores indicate a better rating) for suitability and for realism of the F4L cadavers as training model for these techniques. Secondary outcomes included success rates of the procedures and the time to successful completion of the procedures. Results The mean verbal rating scores for suitability and realism for videolaryngoscopy was 8.3 (95% CI, 7.9–8.6) and 7.2 (95% CI, 6.7–7.6), respectively. For fibreoptic tracheoscopy, suitability was 8.2 (95% CI, 7.9–8.5) and realism 7.5 (95% CI, 7.1–7.8). In videolaryngoscopy, 100% of the procedures were successful. The mean (SD) time until successful tracheal intubation was 34.8 (30.9) s. For fibreoptic tracheoscopy, the success rate was 96.3%, with a mean time of 89.4 (80.1) s. Conclusions We conclude that the F4L cadaver model is a suitable and realistic model to train and teach tracheal intubation with videolaryngoscopy and fibreoptic tracheoscopy to novices in airway management training.
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Affiliation(s)
- Michael W van Emden
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit, PO Box 7057, 1007 MB, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit, PO Box 7057, 1007 MB, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - Patrick Schober
- Department of Anaesthesiology, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - Lothar A Schwarte
- Department of Anaesthesiology, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
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van Emden MW, Geurts JJG, Craenen AMC, Schwarte LA, Schober P. Cricothyroid membrane identification with ultrasonography and palpation in cadavers with a novel fixation technique (Fix for Life): A laboratory investigation. Eur J Anaesthesiol 2020; 37:510-512. [PMID: 32379151 PMCID: PMC7259383 DOI: 10.1097/eja.0000000000001230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Michael W van Emden
- From the Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit, Amsterdam (MWvE, JJGG), Department of Anaesthesiology, UMC Utrecht, Utrecht (AMCC) and Department of Anaesthesiology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands (LAS, PS)
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