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  • Intracranial injectable tumor model: technical advancements

    Final Number:

    Cristian Gragnaniello MD; Filippo Gagliardi M.D.; Remi Nader MD; Alan Siu MD; Zachary N. Litvack MD MCR; Bruno De Luca MD; Anthony J. Caputy MD; Pietro Mortini MD; Kevin Seex MB.ChB., FRACS

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Despite the many years of training in neurosurgery, subspecialty fellowship and learning opportunities in cadaver lab, there is no substitute for experience when dealing with the highly distorted anatomy of a skull base lesion. We describe the technical advancements in the use and composition of a novel polymer Stratathane resin ST-504 derived polymer (SRSDP) to mimic, in the cadaveric model, intra- and extra-axial cranial tumors for use in neurosurgical training.

    Methods: Silicone injected cadaveric heads were used to refine this training model. The SRSDP is initially liquid after mixing, allowing it to be injected into the target area, where it predictably expands and solidifies forming a tumor-like structure. Recent improvements have been made to change its physical characteristics, improving its adhesiveness, texture, subarachnoid spread, deformability and radiological visibility. The polymer injection was performed under fluoroscopic control via a burr-hole which avoided compromising the surgical approach for excision. Inflation of a balloon catheter of desired size was used to displace stiff cadaveric brains and create a void that could be filled with polymer to create tumors of larger sizes.

    Results: In cadaveric surgery the more developed injectable tumor model (ITM) provided an enhanced training experience by simulating more of the challenges of operating on pathology that distorts and surrounds normal anatomy.

    Conclusions: The traditional cadaver lab allows practice in the approach only. The ITM using SRSDP is a novel educational tool that in a relatively simple way, helps trainees learn some of the technical skills required to remove brain tumours. Speeding up the learning curve of operative skills that normally take many years to acquire clinically, would be of benefit to trainees, trainers and possibly patients.

    Patient Care: It would provide a tool for trainees and young surgeons to speed up their learning curve of operative skills in dealing with complex skull base tumors.

    Learning Objectives: By the conclusion of this session, participants should be able to navigate the skull base anatomy distorded by space occupying lesions

    References: 1) Gragnaniello C. Nader R. van Doormaal T. Kamel M. Voormolen EH. Lasio G. Aboud E. Regli L. Tulleken CA. Al-Mefty O.: Skull base tumor model. Journal of Neurosurgery. 113(5):1106-11, 2010 Nov.

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