Skip to main content
  • Enhancing Surgical Skills in Clipping Cerebral Aneurysms and Management of Intraoperative Rupture using the “Live Cadaver” Training Model

    Final Number:

    Emad T. Aboud MD; Hassan Saad MD; Talal E Aboud; Ali F. Krisht MD

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Current training methods for simulating neurovascular procedures lack the combination of life-like conditions and real human anatomy essential for effective surgical training. We previously introduced a realistic cadaver based training method that combined both, the life-like conditions and the real human anatomy for practicing neurovascular procedures and the management of intraoperative complications, In this report we present the effectiveness of this model in enhancing surgical skills in aneurysmal clipping and management of intraoperative aneurysmal rupture.

    Methods: 32 cephalous were used in 21 hands-on workshops. The carotid artery, jugular vein and at least one vertebral artery were cannulated and connected to blood simulant reservoirs. The arterial side then was connected to a pump that provided pulsatile pressure.

    Results: In five courses, we rated the performance of residents for two tasks. First “Clipping cerebral aneurysms”: number of attempts to clip an aneurysm decreased with multiple sessions from 3-5 attempts to one or two. Second “controlling bleeding”: the time to control bleeding from a ruptured aneurysm dropped from 80-160 seconds, to 50 seconds after three sessions of practice in most cases.

    Conclusions: the “Live Cadaver” model is a valuable tool for enhancing surgical skills. It offers an identical environment as that in the operating room allowing “real” surgical practice without endangering patients’ lives. Practicing complex surgical procedures using the live cadaver model can enhance surgical skills and performance of young neurosurgeons and neurosurgery residents.

    Patient Care: by enhancing surgical skills.

    Learning Objectives: after attending this session trainees will be able to learn how to prepare the model and use it in their own institutions, understand its applications and Identify the benefit of practicing on the same anatomy under life-like conditions.

    References: 1- Kimura T, Morita A, Nishimura K, Aiyama H, Itoh H, Fukaya S, Sora S, Ochiai C. Simulation of and training for cerebral aneurysm clipping with 3- dimensional models. Neurosurgery 2009; 65(4):719–25. 2- Oliveira Magaldi M, Nicolato A, Godinho JV, et al. Human placenta aneurysm model for training neurosurgeons in vascular microsurgery. Neurosurgery. 2014;10 (suppl 4):592-600. 3- Alaraj, A.; Luciano, C.J.; Bailey, D.P.; Elsenousi, A.; Roitberg, B.Z.; Bernardo, A.; Banerjee, P.P.; Charbel, F.T. Virtual reality cerebral aneurysm clipping simulation with real-time haptic feedback. Neurosurgery 2015, 11, 52–58. 4- Price J, Naik V, Boodhwani M, Brandys T, Hendry P, Lam BK. A randomized evaluation of simulation training on performance of vascular anastomosis on a high-fidelity in vivo model: the role of deliberate practice. J Thorac Cardiovasc Surg. Sep 2011;142(3):496- 503. 5- Batjer H: Comment on “Effect of the neurosurgeon’s surgical experience on outcomes from intraoperative aneurysmal rupture.” Neurosurgery 57(1):13–14, 2005 6- Torkington J, Smith SG, Rees BI, Darzi A. The role of simulation in surgical training. Ann R Coll Surg Engl. 2000;82:88 –94. 7- Krisht AF, Yoo K, Arnautovic KI, Al-Mefty O. Cavernous sinus tumor model in the canine: a simulation model for cavernous sinus tumor surgery. Neurosurgery. 2005;56:1361–1365; discussion 1365–1366. 8- Boehler ML, Schwind CJ, Rogers DA, et al. A theory-based curriculum for enhancing surgical skillfulness. J Am Coll Surg. 2007;205:492– 497. 9- Cooke DT, Jamshidi R, Guitron J, Karamichalis J. The virtual surgeon: using medical simulation to train the modern surgical resident. Bull Am Coll Surg. 2008;93:26 –31. 10- Malone HR, Syed ON, Downes MS, D'Ambrosio AL, Quest DO, Kaiser MG. Simulation in neurosurgery: a review of computer-based simulation environments and their surgical applications. Neurosurgery. Oct 2010;67(4):1105-1116. 11- Bath J, Lawrence P. Why we need open simulation to train surgeons in an era of workhour restrictions. Vascular. Aug 2011;19(4):175-177. 12- Raymond J, Salazkin I, Gevry G, Nguyen TN. Interventional neuroradiology: the role of experimental models in scientific progress. AJNR Am J Neuroradiol. Mar 2007;28(3):401-405. 13- Yatomi K, Yamamoto M, Mitome-Mishima Y, et al. New experimental model of terminal aneurysms in Swine: technical note. J Neurol Surg A Cent Eur Neurosurg. Nov 2012;73(6):397-400 14- Aboud E, Al-Mefty O, Yasargil MG. New laboratory model for neurosurgical training that simulates live surgery. J Neurosurg. Dec 2002;97(6):1367-1372. 15- Aboud E, Aboud G, Al-Mefty O, Aboud T, Rammos S, Abolfotoh M, Hsu SP, Koga S, Arthur A, Krisht A. "Live cadavers" for training in the management of intraoperative aneurysmal rupture. J Neurosurg. 2015 Nov; 123(5):1339-46 16- Reed AB, Crafton C, Giglia JS, Hutto JD. Back to basics: use of fresh cadavers in vascular surgery training. Surgery 2009; 146: 757–762. 17- Jansen S, Cowie M, Linehan J, Hamdorf JM. Fresh frozen cadaver workshops for advanced vascular surgical training. ANZ J Surg. 2014 Nov;84(11):877-80 18- Mitchell EL, Sevdalis N, Arora S, Azarbal AF, Liem TK, Landry GJ, Moneta GL. A fresh cadaver laboratory to conceptualize troublesome anatomic relationships in vascular surgery. J Vasc Surg. 2012 Apr;55(4):1187-94 19- Benet A, Plata-Bello J, Abla AA, Acevedo-Bolton G, Saloner D, Lawton MT. Implantation of 3D-Printed Patient-Specific Aneurysm Models into Cadaveric Specimens: A New Training Paradigm to Allow for Improvements in Cerebrovascular Surgery and Research. Biomed Res Int. 2015; 2015:939387. PMID: 26539542. 20- Anastakis DJ, Regehr G, Reznick RK et al. Assessment of technical skills transfer from the bench training model to the human model. Am J Surg 1999; 177: 167–170. 21- A. Benet, J. Rincon-Torroella, M. T. Lawton, and J. J. G. S´anchez, “Novel embalming solution for neurosurgical simulation in cadavers: laboratory investigation,” Journal of Neurosurgery, vol.120, no. 5, pp. 1229–1237, 2014. 22- Anderson SD: Practical light embalming technique for use in the surgical fresh tissue dissection laboratory. Clin Anat 2006; 19: 8–11. 23- Emad T Aboud “Method and Apparatus for Surgical Training”. U S Patent No US 6,790,043. Sep 2004. 24- Aboud ET, Krisht AF, O’Keeffe T, Nader R, Hassan M, Stevens CM, et al: Novel simulation for training trauma surgeons. J Trauma 71:1484–1490, 2011 25- Aboud ET, Aboud G, Aboud T. "Live cadavers" for practicing airway management. Mil Med. 2015 Mar;180(3 Suppl):165-70

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy