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  • Simulation of Ventriculostomy Placement Utilizing a Novel Fresh Tissue Cadaveric Cerebrospinal Fluid Perfusion Model

    Final Number:

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

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: The introduction of residents to basic procedural and surgical skills in a simulated environment prior to their performance in the patient environment is increasingly necessary. Current models for learning of ventriculostomy placement lack the visual, tactile and/or physiologic feedback of a live patient. We present a novel model of cadaveric CSF perfusion which successfully replicates all of these elements.

    Methods: To prove feasibility, six fresh cadavers were obtained according to the standard operating procedure of the University of Southern California Fresh Tissue Dissection Laboratory. A mid-cervical laminectomy and midline durotomy were performed in each, and a 12 french pediatric arterial catheter was inserted into the subarachnoid space directed superiorly. The dura and skin were closed in a watertight fashion, and the subarachnoid space was infused with saline utilizing a Biomedicus BP80 bio-pump at 1100-1300rpm to achieve a CSF pressure of 15 to 30 mmHg. First year neurosurgical residents and neuro-critical care fellows attempted to place a standard frontal ventriculostomy via a twist-drill burr hole. Verification of placement into the ventricle was confirmed by return of CSF. Trainee confidence was assessed via a self-reported questionnaire.

    Results: Successful cannulation of the ventricular system was achieved in all cases, as confirmed by return of simulated CSF. In select cases, verification of catheter placement was also achieved by direct endoscopic visualization of the catheter within the ventricle. All participants stated that the tactile sensation of drilling and catheter placement accurately reflected that of a live patient, including entry into a pressurized ventricle and return of CSF. Self-reported trainee confidence was improved following the procedure in all cases.

    Conclusions: A perfusion-based cadaveric model of CSF flow can accurately replicate the experience of ventriculostomy placement in a live patient. This constitutes a novel and valuable training model for ventriculostomy placement and potentially for other procedures involving the CSF space.

    Patient Care: Early exposure of resident trainees to ventriculostomy placement in a controlled, simulated setting will improve their competency when performing the procedure in live patients, and improve the speed, efficiency, and safety of the procedure in trauma or other neurosurgical patients requiring emergent ventricular access.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of emerging simulation techniques in neurosurgical training, 2) Describe the procedure involved in producing the CSF perfusion model, and 3) Discuss the possible application of a fresh-tissue cadaveric CSF perfusion model to the learning of ventriculostomy placement and other procedures requiring access to the CSF space.


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