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  • Reconstitution of the Intraventricular Cerebrospinal Fluid System Using a Perfusion-Based Fresh-Tissue Cadaveric Model: A Novel Training Paradigm for Intraventricular Neuro-endoscopic Surgery

    Final Number:

    Jesse Winer MD; Richard Aaron Robison MD; Daniel R. Kramer MD; Ifije Ohiorhenuan MD, PhD; Michael Minetti BS, RRT; Steven L. Giannotta MD; Gabriel Zada MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Adequate resident exposure to highly-specialized neurosurgical procedures (i.e. neuro-endoscopy) and alternative surgical educational models are at an increasing premium. We aimed to develop a novel cadaver-based model to simulate intraventricular neuro-endoscopic procedures.

    Methods: Six fresh cadavers were utilized to demonstrate feasibility of the proposed model at the Keck USC fresh-tissue dissection laboratory. In each specimen, a cervical laminectomy and 3mm midline durotomy were performed, followed by insertion of a 12-guage pediatric arterial catheter into the intradural/subarachnoid space. Following a watertight, multilayer closure, saline and water were infiltrated into the catheter via a Medtronic Bio-pump (BP80) to reconstitute the CSF contents to a pressure of 15-30mm Hg. The specimen was placed in prone position, and a neurosurgical trainee was instructed to achieve intraventricular access via a right frontal burr-hole approach and trocar-based neuroendoscopic system with high-definition monitor and recording capability. The aim was to identify normal intraventricular anatomy of the Foramen of Monro and lateral/third ventricles, as well as perform an endoscopic third ventriculostomy and septum pellucidotomy when possible. Trainee confidence in the procedure was assessed via self-reported questionnaire.

    Results: Successful reconstitution and access of the intraventricular system, defined as identification of the normal lateral and third ventricular structures, was achieved in 4 of 6 specimens (Figures 1-7). ETV and septum pellucidotomy were performed in 4 and 67% of attempted cases, respectively. Although adequate “CSF” perfusion of the ventricles was confirmed in all attempts by flow from the ventricular trocar, cerebral structures did not always maintain full integrity due to varying conditions of the specimens and variations in ventricular size. Self-reported trainee confidence in performing intraventricular neuro-endoscopic procedures improved following all simulations.

    Conclusions: The intraventricular CSF pathways can be successfully reconstituted via a perfusion-based cadaveric model, thus serving as a novel and feasible educational alternative for intraventricular neuro-endoscopic operations.

    Patient Care: Improved surgeon education and training will make operative procedures and patient care safer and more efficient in the future.

    Learning Objectives: By the conclusion of this session participants should be able to understand and potentially replicate our cadaveric model for training in ventricular neuro-endoscopy.


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