Advertisement

Training and Standards

  • Ephraim W. Church
  • Kevin M. Cockroft
Chapter

Abstract

It hardly needs to be stated that vascular neurosurgery has changed dramatically over the past 50 years. As neuroendovascular surgery has evolved, more cerebrovascular disease has come to be treated with these techniques. At the same time, fewer but possibly more complex aneurysms must be treated with open cerebrovascular techniques. Together, these changes present unique challenges for training programs and practice standards within vascular neurosurgery. In this chapter, we outline the historical context of training guidelines and certification in neuroendovascular and open cerebrovascular neurosurgery. We then review the current status of these efforts including the Committee on Advanced Subspecialty Training (CAST) certification and other training research and initiatives. We briefly review guidelines for specific operations, as well as hospital privileges. An additional aspect of training and standards, the maintenance of certification process, is discussed in the context of neuroendovascular surgery. We then turn our attention to open cerebrovascular neurosurgery, where fewer but perhaps more complex aneurysms present unique challenges for training the next generation of open cerebrovascular surgeons as well as maintaining standards in this area. Possible solutions to these challenges including simulation training and fellowship training in high-volume centers are discussed. We also review guidelines for competence including CAST certification in cerebrovascular neurosurgery. In conclusion, we offer a checklist of recommendations regarding training and standards in neuroendovascular and open cerebrovascular neurosurgery.

References

  1. 1.
    Higashida RT, Hopkins LN, Berenstein A, Halbach VV, Kerber C. Program requirements for residency/fellowship education in neuroendovascular surgery/interventional neuroradiology: a special report on graduate medical education. AJNR Am J Neuroradiol. 2000;21(6):1153–9. PubMed PMID: 10871032PubMedGoogle Scholar
  2. 2.
    Hopkins LN, Higashida RT, Piepgras DG. Perspectives on training standards in neuroendovascular therapeutics. Neurosurg Clin N Am. 2000;11(1):187–90. x. Review. PubMed PMID: 10565877CrossRefPubMedGoogle Scholar
  3. 3.
    Spiotta AM, Turner RD, Turk AS, Chaudry MI. The case for a milestone-based simulation curriculum in modern neuroendovascular training. J Neurointerv Surg. 2016;8(4):429–33.  https://doi.org/10.1136/neurintsurg-2014-011546. Epub 2015 Feb 2. Review. PubMed PMID: 25646131CrossRefPubMedGoogle Scholar
  4. 4.
    Chaturvedi S, Dumont AS. The learning curve for neuroendovascular procedures: how important is it? Neurology. 2009;72(23):1974–5.  https://doi.org/10.1212/WNL.0b013e3181a92c6f. Epub 2009 Apr 29. PubMed PMID: 19403883CrossRefPubMedGoogle Scholar
  5. 5.
    Singh V, Gress DR, Higashida RT, Dowd CF, Halbach VV, Johnston SC. The learning curve for coil embolization of unruptured intracranial aneurysms. AJNR Am J Neuroradiol. 2002;23(5):768–71. PubMed PMID: 12006274PubMedGoogle Scholar
  6. 6.
    Connors JJ III, Sacks D, Furlan AJ, Selman WR, Russell EJ, Stieg PE, Hadley MN, NeuroVascular Coalition Writing Group, Wojak JC, Koroshetz WJ, Heros RC, Strother CM, Duckwiler GR, Durham JD, Tom-sick TO, Rosenwasser RH, CG MD, Haughton VM, Derdeyn CP, Wechsler LR, Hudgins PA, Alberts MJ, Raabe RD, Gomez CR, Cawley CM 3rd, Krol KL, Futrell N, Hauser RA, Frank JI. Training, competency, and credentialing standards for diagnostic cervicocerebral angiography, carotid stenting, and cerebrovascular intervention: a joint statement from the American Academy of Neurology, the American Association of Neurological Surgeons, the American Society of Interventional and Therapeutic Neuroradiology, the American Society of Neuroradiology, the Congress of Neurological Surgeons, the AANS/CNS Cerebrovascular Section, and the Society of Interventional Radiology. J Vasc Interv Radiol. 2009;20(7 Suppl):S292–301.  https://doi.org/10.1016/j.jvir.2009.04.003. PubMed PMID: 19560013CrossRefPubMedGoogle Scholar
  7. 7.
    Dion JE, Gates PC, Fox AJ, Barnett HJ, Blom RJ. Clinical events following neuroangiography: a prospective study. Stroke. 1987;18(6):997–1004. PubMed PMID: 3686597CrossRefPubMedGoogle Scholar
  8. 8.
    Raaymakers TW, Rinkel GJ, Limburg M, Algra A. Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis. Stroke. 1998;29(8):1531–8. PubMed PMID: 9707188CrossRefPubMedGoogle Scholar
  9. 9.
    Hopkins LN, Strother CM. Neuroendovascular training. Neurosurg Clin N Am. 1994;5(3):565–7. PubMed PMID: 8086807CrossRefPubMedGoogle Scholar
  10. 10.
    Program requirements for residency/fellowship education in neuroendovascular surgery/interventional neuroradiology: special report on graduate medical education: a joint statement by the American Society of Interventional and Therapeutic Neuroradiology, Congress of Neurological Surgeons and American Association of Neurological Surgeons, American Society of Neuroradiology. Neurosurgery. 2000;46(6):1486–93; discussion 1494–7. PubMed PMID: 10834652.Google Scholar
  11. 11.
    Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Endovascular Surgical Neuroradiology. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/163-182-422_endovascular_neuroradiology_2016_1-YR.pdf. Accessed July 2016.
  12. 12.
    Howington JU, Hopkins LN, Piepgras DG, Harbaugh RE. Training standards in endovascular neurosurgery. Neurosurg Clin N Am. 2005;16(2):445–9. xi. Review. PubMed PMID: 15694173CrossRefPubMedGoogle Scholar
  13. 13.
    Richling B, Lasjaunias P, Byrne J, Lindsay KW, Matgé G, Trojanowski T. Standards of training in endovascular neurointerventional therapy: as approved by the ESNR, EBNR, UEMS Section of Neurosurgery and EANS (February 2007). Enclosed the standards of practice as endorsed by the WFITN. Acta Neurochir. 2007;149(6):613–6. discussion 616. Epub 2007 May 21. PubMed PMID: 17514350CrossRefPubMedGoogle Scholar
  14. 14.
    Byrne JV. Training of neurointerventional therapists. Neuroradiology. 2008;50(3):203–4.  https://doi.org/10.1007/s00234-008-0360-3. PubMed PMID: 18246333CrossRefPubMedGoogle Scholar
  15. 15.
    Shin DS, Park SQ, Kang HS, Yoon SM, Cho JH, Lim DJ, Baik MW, Kwon OK, Kim BT. Standards for endovascular neurosurgical training and certification of the Society of Korean Endovascular Neurosurgeons 2013. J Korean Neurosurg Soc. 2014;55(3):117–24.  https://doi.org/10.3340/jkns.2014.55.3.117. Epub 2014 Mar 31. Review. PubMed PMID: 24851145; PubMed Central PMCID: PMC4024809CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Harbaugh RE, Agarwal A. Training residents in endovascular neurosurgery. Neurosurgery. 2006;59(5 Suppl 3):S277–81. discussion S3-13. Review. PubMed PMID: 17053613PubMedGoogle Scholar
  17. 17.
    Sauvageau E, Hopkins LN. Training in cerebrovascular disease: do we need to change the way we train residents. Neurosurgery. 2006;59(5 Suppl 3):S282–6. discussion S3–13. Review. PubMed PMID: 17053614PubMedGoogle Scholar
  18. 18.
    Committee on Advanced Subspecialty Training (CAST) Society of Neurological Surgeons. Program requirements for fellowship training in cerebrovascular neurosurgery. http://www.societyns.org/fellowships/requirements-cv.html. Accessed July 2016.
  19. 19.
    Committee on Advanced Subspecialty Training (CAST) Society of Neurological Surgeons. Program requirements for fellowship training in neuroendovascular surgery. http://www.societyns.org/pdfs/CAST_NES_ProgramRequirements.pdf. Accessed July 2016.
  20. 20.
    Spiotta AM, Rasmussen PA, Masaryk TJ, Benzel EC, Schlenk R. Simulated diagnostic cerebral angiography in neurosurgical training: a pilot program. J Neurointerv Surg. 2013;5(4):376–81.  https://doi.org/10.1136/neurintsurg-2012-010319. Epub 2012 May 10. PubMed PMID: 22576472CrossRefPubMedGoogle Scholar
  21. 21.
    Ernst M, Kriston L, Romero JM, Frölich AM, Jansen O, Fiehler J, Buhk JH. Quantitative evaluation of performance in interventional neuroradiology: an integrated curriculum featuring theoretical and practical challenges. PLoS One. 2016;11(2):e0148694.  https://doi.org/10.1371/journal.pone.0148694. eCollection 2016. PubMed PMID: 26848840; PubMed Central PMCID: PMC4743848CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Miranpuri AS, Nickele CM, Akture E, Royalty K, Niemann DB. Neuroangiography simulation using a silicone model in the angiography suite improves trainee skills. J Neurointerv Surg. 2014;6(7):561–4.  https://doi.org/10.1136/neurintsurg-2013-010826. Epub 2013 Sep 23. PubMed PMID: 24062256CrossRefPubMedGoogle Scholar
  23. 23.
    Fargen KM, Siddiqui AH, Veznedaroglu E, Turner RD, Ringer AJ, Mocco J. Simulator based angiography education in neurosurgery: results of a pilot educational program. J Neurointerv Surg. 2012;4(6):438–41.  https://doi.org/10.1136/neurintsurg-2011-010128. Epub 2011 Oct 20. PubMed PMID: 22015637CrossRefPubMedGoogle Scholar
  24. 24.
    Fargen KM, Arthur AS, Bendok BR, Levy EI, Ringer A, Siddiqui AH, Veznedaroglu E, Mocco J. Experience with a simulator-based angiography course for neurosurgical residents: beyond a pilot program. Neurosurgery. 2013;73(Suppl 1):46–50.  https://doi.org/10.1227/NEU.0000000000000059. PubMed PMID: 24051882CrossRefPubMedGoogle Scholar
  25. 25.
    Grunwald IQ, Romeike B, Eymann R, Roth C, Struffert T, Reith W. An experimental aneurysm model: a training model for neurointerventionalists. Interv Neuroradiol. 2006;12(1):17–24. Epub 2006 Jun 15. PubMed PMID: 20569546; PubMed Central PMCID: PMC3355307CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Kerber CW, Hecht ST, Knox K. Arteriovenous malformation model for training and research. AJNR Am J Neuroradiol. 1997;18(7):1229–32. PubMed PMID: 9282846PubMedGoogle Scholar
  27. 27.
    Kono K, Shintani A, Okada H, Terada T. Preoperative simulations of endovascular treatment for a cerebral aneurysm using a patient-specific vascular silicone model. Neurol Med Chir (Tokyo). 2013;53(5):347–51. PubMed PMID: 23708228CrossRefGoogle Scholar
  28. 28.
    Namba K, Mashio K, Kawamura Y, Higaki A, Nemoto S. Swine hybrid aneurysm model for endovascular surgery training. Interv Neuroradiol. 2013;19(2):153–8. Epub 2013 May 21. PubMed PMID: 23693037; PubMed Central PMCID: PMC3670052.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Paramasivam S, Baltsavias G, Psatha E, Matis G, Valavanis A. Silicone models as basic training and research aid in endovascular neurointervention—a single-center experience and review of the literature. Neurosurg Rev. 2014;37(2):331–7; discussion 337. doi:  https://doi.org/10.1007/s10143-014-0518-x. Epub 2014 Jan 25. Review. PubMed PMID: 24463914.
  30. 30.
    Suzuki Y, Fujitsuka M, Chaloupka JC. Simulation of endovascular neurointervention using silicone models: imaging and manipulation. Neurol Med Chir (Tokyo). 2005;45(11):567–72. discussion 572–3. PubMed PMID: 16308515CrossRefGoogle Scholar
  31. 31.
    Mitha AP, Almekhlafi MA, Janjua MJ, Albuquerque FC, McDougall CG. Simulation and augmented reality in endovascular neurosurgery: lessons from aviation. Neurosurgery. 2013;72(Suppl 1):107–14.  https://doi.org/10.1227/NEU.0b013e31827981fd. PubMed PMID: 23254798CrossRefPubMedGoogle Scholar
  32. 32.
    Barr JD, Connors JJ III, Sacks D, Wojak JC, Becker GJ, Cardella JF, Chopko B, Dion JE, Fox AJ, Higashida RT, Hurst RW, Lewis CA, Matalon TA, Nesbit GM, Pollock JA, Russell EJ, Seidenwurm DJ, Wallace RC, SIR Standards of Practice Committees. Quality improvement guidelines for the performance of cervical carotid angioplasty and stent placement. AJNR Am J Neuroradiol. 2003;24(10):2020–34. PubMed PMID: 14625227PubMedGoogle Scholar
  33. 33.
    Writing Group for the American Academy of Neurology, AANS/CNS Cerebrovascular Section, Society of NeuroInterventional Surgery, and the Society of Vascular & Interventional Neurology, Meyers PM, Schumacher HC, Alexander MJ, Derdeyn CP, Furlan AJ, Higashida RT, Moran CJ, Tarr RW, Heck DV, Hirsch JA, Jensen ME, Linfante I, CG MD, Nesbit GM, Rasmussen PA, Tomsick TA, Wechsler LR, Wilson JA, Zaidat OO. Performance and training standards for endovascular ischemic stroke treatment. J Neurointerv Surg. 2009;1(1):10–2.  https://doi.org/10.1136/jnis.2009.000687. Erratum in: J Neurointerv Surg. 2009 Dec;1(2):153. Wilson, J R [corrected to Wilson, J A]. PubMed PMID: 21994099CrossRefGoogle Scholar
  34. 34.
    Lavine SD, Cockroft K, Hoh B, Bambakidis N, Khalessi AA, Woo H, Riina H, Siddiqui A, Hirsch JA, Chong W, Rice H, Wenderoth J, Mitchell P, Coulthard A, Signh TJ, Phatorous C, Khangure M, Klurfan P, Ter Brugge K, Iancu D, Gunnarsson T, Jansen O, Muto M, Szikora I, Pierot L, Brouwer P, Gralla J, Renowden S, Andersson T, Fiehler J, Turjman F, White P, Januel AC, Spelle L, Kulcsar Z, Chapot R, Biondi A, Dima S, Taschner C, Szajner M, Krajina A, Sakai N, Matsumaru Y, Yoshimura S, Ezura M, Fujinaka T, Iihara K, Ishii A, Higashi T, Hirohata M, Hyodo A, Ito Y, Kawanishi M, Kiyosue H, Kobayashi E, Kobayashi S, Kuwayama N, Matsumoto Y, Miyachi S, Murayama Y, Nagata I, Nakahara I, Nemoto S, Niimi Y, Oishi H, Satomi J, Satow T, Sugiu K, Tanaka M, Terada T, Yamagami H, Diaz O, Lylyk P, Jayaraman MV, Patsalides A, Gandhi CD, Lee SK, Abruzzo T, Albani B, Ansari SA, Arthur AS, Baxter BW, Bulsara KR, Chen M, Almandoz JE, Fraser JF, Heck DV, Hetts SW, Hussain MS, Klucznik RP, Leslie-Mawzi TM, Mack WJ, McTaggart RA, Meyers PM, Mocco J, Prestigiacomo CJ, Pride GL, Rasmussen PA, Starke RM, Sunenshine PJ, Tarr RW, Frei DF, Ribo M, Nogueira RG, Zaidat OO, Jovin T, Linfante I, Yavagal D, Liebeskind D, Novakovic R, Pongpech S, Rodesch G, Soderman M, Taylor A, Krings T, Orbach D, Picard L, Suh DC, Zhang HQ. Training guidelines for endovascular stroke intervention: an international multi-society consensus document. Neuroradiology. 2016;58(6):537–41. [Epub ahead of print] PubMed PMID: 27075466CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Calligaro KD, Toursarkissian B, Clagett GP, Towne J, Hodgson K, Moneta G, Sidawy AN, Cronenwett JL, Clinical Practice Council, Society for Vascular Surgery. Guidelines for hospital privileges in vascular and endovascular surgery: recommendations of the Society for Vascular Surgery. J Vasc Surg. 2008;47(1):1–5. Epub 2007 Dec 3. PubMed PMID: 18060729CrossRefPubMedGoogle Scholar
  36. 36.
    Murphy TP, Kuo MD, Benenati JF, Dixon RG, Goodwin SC, Hicks M, Miller DL, Sidhu MK, Silberzweig JE, Vedantham S, Cardella JF, Society of Interventional Radiology. Position statement by the Society of Interventional Radiology: maintenance of privileges for image-guided interventions. J Vasc Interv Radiol. 2011;22(10):1353–4.  https://doi.org/10.1016/j.jvir.2011.08.001. PubMed PMID: 21961978CrossRefPubMedGoogle Scholar
  37. 37.
    Hirsch JA, Becker GJ, Derdeyn CP, Jayaraman MV, Traynelis VC, Meyers PM. Maintenance of certification: part 2—continuous certification. J Neurointerv Surg. 2014;6(2):156–60.  https://doi.org/10.1136/neurintsurg-2013-010693. Epub 2013 Mar 15. Review. PubMed PMID: 23502705CrossRefPubMedGoogle Scholar
  38. 38.
    Hirsch JA, Meyers PM. Maintenance of certification: historical context. J Neurointerv Surg. 2013;5(6):612–4.  https://doi.org/10.1136/neurintsurg-2012-010538. Epub 2012 Oct 6. Review. PubMed PMID: 23042747CrossRefPubMedGoogle Scholar
  39. 39.
    Picard L, Bracard S, Rodesch G. WFITN recommendations for certification and maintenance of competence in interventional neuroradiology. (Therapeutic Neurointervention/Endovascular Neurosurgery). Interv Neuroradiol. 2014;20(3):249–50.  https://doi.org/10.15274/NRJ-2014-10045. Epub 2014 Jun 17. PubMed PMID: 24976085; PubMed Central PMCID: PMC4178763CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Almefty RO, Spetzler RF. Training aneurysm surgeons in the modern era. World Neurosurg. 2014;82(3–4):e419–20.  https://doi.org/10.1016/j.wneu.2013.03.060. Epub 2013 Mar 27. PubMed PMID: 23542392CrossRefPubMedGoogle Scholar
  41. 41.
    Lai L, Morgan MK. The impact of changing intracranial aneurysm practice on the education of cerebrovascular neurosurgeons. J Clin Neurosci. 2012;19(1):81–4.  https://doi.org/10.1016/j.jocn.2011.07.008. Epub 2011 Nov 8. PubMed PMID: 22071461CrossRefPubMedGoogle Scholar
  42. 42.
    Vindlacheruvu RR, Dervin JE, Kane PJ. The impact of interventional neuroradiology on neurosurgical training. Ann R Coll Surg Engl. 2003;85(1):3–9. PubMed PMID: 12585622; PubMed Central PMCID: PMC1964337CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Le Reste PJ, Henaux PL, Riffaud L, Haegelen C, Morandi X. Influence of cumulative surgical experience on the outcome of poor-grade patients with ruptured intracranial aneurysm. Acta Neurochir. 2015;157(1):1–7.  https://doi.org/10.1007/s00701-014-2241-3. Epub 2014 Sep 25. PubMed PMID: 25248329CrossRefPubMedGoogle Scholar
  44. 44.
    Sanai N, Caldwell N, Englot DJ, Lawton MT. Advanced technical skills are required for microsurgical clipping of posterior communicating artery aneurysms in the endovascular era. Neurosurgery. 2012;71(2):285–94; discussion 294–5. doi:  https://doi.org/10.1227/NEU.0b013e318256c3eb. PubMed PMID: 22472555.
  45. 45.
    Heros RC. Training the cerebrovascular surgeon for the 21st century. Neurol Res. 2002;24(Suppl 1):S7–12. PubMed PMID: 12074441CrossRefPubMedGoogle Scholar
  46. 46.
    Abla AA, Lawton MT. Three-dimensional hollow intracranial aneurysm models and their potential role for teaching, simulation, and training. World Neurosurg. 2015;83(1):35–6.  https://doi.org/10.1016/j.wneu.2014.01.015. Epub 2014 Jan 29. PubMed PMID: 24486860CrossRefPubMedGoogle Scholar
  47. 47.
    Santiago BM, Cunha E, Sá M. How do we maintain competence in aneurysm surgery. Acta Neurochir. 2015;157(1):9–11.  https://doi.org/10.1007/s00701-014-2265-8. Epub 2014 Nov 14. PubMed PMID: 25391972CrossRefPubMedGoogle Scholar
  48. 48.
    Alshafai N, Falenchuk O, Cusimano MD. International differences in the management of intracranial aneurysms: implications for the education of the next generation of neurosurgeons. Acta Neurochir. 2015;157(9):1467–75.  https://doi.org/10.1007/s00701-015-2494-5. Epub 2015 Aug 1. PubMed PMID: 26231628CrossRefPubMedGoogle Scholar
  49. 49.
    Marinho P, Thines L, Verscheure L, Mordon S, Lejeune JP, Vermandel M. Recent advances in cerebrovascular simulation and neuronavigation for the optimization of intracranial aneurysm clipping. Comput Aided Surg. 2012;17(2):47–55.  https://doi.org/10.3109/10929088.2011.653403. Review. PubMed PMID: 22348657CrossRefPubMedGoogle Scholar
  50. 50.
    Chugh AJ, Pace JR, Singer J, Tatsuoka C, Hoffer A, Selman WR, Bambakidis NC. Use of a surgical rehearsal platform and improvement in aneurysm clipping measures: results of a prospective, randomized trial. J Neurosurg. 2017;126(3):838–44.  https://doi.org/10.3171/2016.1.JNS152576. Epub 2016 May 13. PubMed PMID: 27177182.
  51. 51.
    Alaraj A, Luciano CJ, Bailey DP, Elsenousi A, Roitberg BZ, Bernardo A, Banerjee PP, Charbel FT. Virtual reality cerebral aneurysm clipping simulation with real-time haptic feedback. Neurosurgery. 2015;11(Suppl 2):52–8.  https://doi.org/10.1227/NEU.0000000000000583. PubMed PMID: 25599200; PubMed Central PMCID: PMC4340784CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Wong GK, Zhu CX, Ahuja AT, Poon WS. Craniotomy and clipping of intracranial aneurysm in a stereoscopic virtual reality environment. Neurosurgery. 2007;61(3):564–8. discussion 568–9. PubMed PMID: 17881970CrossRefPubMedGoogle Scholar
  53. 53.
    Wong GK, Zhu CX, Ahuja AT, Poon WS. Stereoscopic virtual reality simulation for microsurgical excision of cerebral arteriovenous malformation: case illustrations. Surg Neurol. 2009;72(1):69–72; discussion 72–3. doi:  https://doi.org/10.1016/j.surneu.2008.01.049. PubMed PMID: 19559930.
  54. 54.
    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;123(5):1339–46.  https://doi.org/10.3171/2014.12.JNS141551. Epub 2015 Jul 3. Erratum in: J Neurosurg. 2015 Nov;123(5):1347. PubMed PMID: 26140492CrossRefPubMedGoogle Scholar
  55. 55.
    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.  https://doi.org/10.1155/2015/939387. Epub 2015 Oct 11. PubMed PMID: 26539542; PubMed Central PMCID: PMC4619899CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    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; discussion 725–6. doi:  https://doi.org/10.1227/01.NEU.0000354350.88899.07. PubMed PMID: 19834377.
  57. 57.
    Mashiko T, Otani K, Kawano R, Konno T, Kaneko N, Ito Y, Watanabe E. Development of three-dimensional hollow elastic model for cerebral aneurysm clipping simulation enabling rapid and low cost prototyping. World Neurosurg. 2015;83(3):351–61.  https://doi.org/10.1016/j.wneu.2013.10.032. Epub 2013 Oct 16. Review. PubMed PMID: 24141000CrossRefPubMedGoogle Scholar
  58. 58.
    Oliveira Magaldi M, Nicolato A, Godinho JV, Santos M, Prosdocimi A, Malheiros JA, Lei T, Belykh E, Almefty RO, Almefty KK, Preul MC, Spetzler RF, Nakaji P. Human placenta aneurysm model for training neurosurgeons in vascular microsurgery. Neurosurgery. 2014;10(Suppl 4):592–600; discussion 600–1. doi:  https://doi.org/10.1227/NEU.0000000000000553. PubMed PMID: 25409330.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryPenn State Milton S. Hershey Medical Center and Penn State University College of MedicineHersheyUSA

Personalised recommendations