Biological Models for Neurosurgical Training in Microanastomosis

Abstract

Cerebrovascular neurosurgeons must be proficient in microvascular operative techniques. Complex microvascular surgical skills are needed for the treatment of many cerebrovascular pathologies, including moyamoya disease, complex aneurysms, intracranial and extracranial stenosis of large vessels, and iatrogenic vascular injuries. Microvascular techniques should be developed before they are needed in the operating room so that neurosurgeons are prepared when presented with a cerebrovascular problem or emergency.

In this chapter, we describe basic biological models for neurosurgical training in microanastomosis, including poultry arteries, human and bovine placentas, rat vessels, and cadaveric material. We also provide information on appropriate laboratory setup. Biological microanastomosis training and experience should be an element in a comprehensive training program that proceeds in a graduated fashion, beginning first with training that uses dry materials, followed by “wet” training that uses biological simulation models, and finally culminating with surgery on living patients. Biological models can also serve as an effective means to keep infrequently used skills sharp and to practice new skills or innovative techniques before deploying them in patient care.

Results from the skills training and validation experiments discussed below, supplemented by insight from modern neurophysiological data, provide the background data necessary for developing an evidence-based microsurgical training paradigm. Numerous well-developed and validated biological models are available for microvascular anastomosis training. Microsurgical anastomosis practice should be implemented in all neurosurgical departments for the training of residents, fellows, and cerebrovascular attending staff.