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  • Development of a Perfusion-Based Cadaveric Simulation Model Integrated into Neurosurgical Training

    Final Number:

    Joshua Bakhsheshian MD; Gabriel Zada MD; Jonathan Russin MD; Martin H. Pham MD; Eisha Christian MD; Michael Minneti; Jesse Winer MD; Richard Aaron Robison MD; William J. Mack MD; Steven L. Giannotta MD

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting - Late Breaking Science

    Introduction: Novel methodologies providing realistic simulation of the neurosurgical operating room (OR) environment are currently needed, particularly for highly subspecialized operations with steep learning curves, high-risk profiles, and demands for advanced psychomotor skills.

    Methods: At the USC Keck School of Medicine Fresh Tissue Dissection Laboratory between 2012-2016, 43 cadaveric specimens underwent cannulation of the femoral or carotid artery and artificial perfusion of the arterial system, and/or cannulation of the intradural cervical spine for intrathecal reconstitution of the cerebrospinal fluid (CSF) system. Models were used to train neurosurgical residents in various procedures. Self-assessment of pre- and post-procedure trainee confidence (Likert) scores were compared for each module.

    Results: The following novel procedural training methodologies were successfully established: management of a carotid artery injury during endoscopic endonasal approach (n=12), endoscopic endonasal CSF leak repair (n=6) with fluorescein perfusion, carotid endarterectomy (n=4), extracranial-to-intracranial bypass (n=2), insertion of ventriculostomy catheter (n=7), lumbar laminectomy with durotomy repair (n=9), and intraventricular neuro-endoscopy with septum pellucidotomy and third ventriculostomy (n=12). In all instances trainees reported improvement in their post-procedural confidence scores, with mean pre- and post-procedural Likert scores being 2.85 ± 1.09 and 4.14 ± 0.93 (p<0.05).

    Conclusions: Augmentation of fresh cadaveric specimens via reconstitution of vascular and CSF pathways is a feasible methodology for complimenting surgical training in numerous neurosurgical procedures, and may hold implications in the future of neurosurgical resident education.

    Patient Care: Given the need for directed practice to gain competence and expertise in a procedure, the incorporation of simulators in neurosurgical training is very attractive and becoming a mandatory component of many surgical residency programs. The use of simulated surgical models allow for a safe and controlled environment for trainees to hone their technical skills without placing patients at risk. Simulators provide the opportunity for repeated practice of specific skill-sets on a scale that may not be achievable from clinical practice alone. To this end, many surgical resident training programs have employed the use of simulation scenarios to complement their surgical training. Simulation training models have been described in synthetic replica models animal studies and using virtual reality, but many of these models have been limited by anatomical differences, and by being unrealistic and artificial. For these reasons, a significant amount of research has been placed on developing more realistic simulations with human cadaveric models. The use of cadaveric simulation models augmented with perfusion to reconstitute the cerebrospinal fluid or vascular system provides an even a more realistic opportunity to develop the psychomotor skills that are essential in highly–specialized operative procedures.The authors report their experience with the development of a curriculum and catalogue of instructional surgical modules utilizing lifelike cadaveric perfusion-based simulation models that provide hands on training for developing fundamental skills required across a broad spectrum of procedures within neurosurgery. Our recent institutional experience with seven procedures, spanning in neurosurgical complexity, is presented in this presentation.

    Learning Objectives: To describe the development of a curriculum for using perfusion-based cadaveric simulation models in a “Mock Operating Room” for neurosurgical procedures.


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