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Biological Models for Neurosurgical Training in Microanastomosis

  • Evgenii Belykh
  • Michael A. Bohl
  • Kaith K. Almefty
  • Mark C. Preul
  • Peter Nakaji
Chapter
Part of the Comprehensive Healthcare Simulation book series (CHS)

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.

Keywords

Anastomosis Aneurysm Arteriovenous malformation Artery Biological model Bypass Chicken wing Microanastomosis Microsurgery Placenta Rat Stenosis Surgical training Turkey wing Vascular injury 

Abbreviation

STA

Superficial Temporal Artery

IACUC

Institutional Animal Care and Use Committee

Notes

Acknowledgments

The authors thank the Neuroscience Publications staff at Barrow Neurological Institute in Phoenix, Arizona, for their kind assistance in the preparation of this manuscript.

References

  1. 1.
    Krings T, Mandell DM, Kiehl TR, et al. Intracranial aneurysms: from vessel wall pathology to therapeutic approach. Nat Rev Neurol. 2011;7(10):547–59.CrossRefGoogle Scholar
  2. 2.
    Sun H, Safavi-Abbasi S, Spetzler RF. Retractorless surgery for intracranial aneurysms. J Neurosurg Sci. 2016;60(1):54–69.PubMedGoogle Scholar
  3. 3.
    Belykh E, Byvaltsev V. Off-the-job microsurgical training on dry models: Siberian experience. World Neurosurg. 2014;82(1–2):20–4.CrossRefGoogle Scholar
  4. 4.
    Kshettry VR, Mullin JP, Schlenk R, Recinos PF, Benzel EC. The role of laboratory dissection training in neurosurgical residency: results of a national survey. World Neurosurg. 2014;82(5):554–9.CrossRefGoogle Scholar
  5. 5.
    Abla AA, Uschold T, Preul MC, Zabramski JM. Comparative use of turkey and chicken wing brachial artery models for microvascular anastomosis training. J Neurosurg. 2011;115(6):1231–5.CrossRefGoogle Scholar
  6. 6.
    Hino A. Training in microvascular surgery using a chicken wing artery. Neurosurgery. 2003;52(6):1495–7; discussion 7–8.CrossRefGoogle Scholar
  7. 7.
    Colpan ME, Slavin KV, Amin-Hanjani S, Calderon-Arnuphi M, Charbel FT. Microvascular anastomosis training model based on a turkey neck with perfused arteries. Neurosurgery. 2008;62(5 Suppl 2):ONS407-10; discussion ONS10-1.CrossRefGoogle Scholar
  8. 8.
    Olabe J, Olabe J. Microsurgical training on an in vitro chicken wing infusion model. Surg Neurol. 2009;72(6):695–9.CrossRefGoogle Scholar
  9. 9.
    Jusue-Torres I, Sivakanthan S, Pinheiro-Neto CD, Gardner PA, Snyderman CH, Fernandez-Miranda JC. Chicken wing training model for endoscopic microsurgery. J Neurol Surg B Skull Base. 2013;74(5):286–91.CrossRefGoogle Scholar
  10. 10.
    Belykh E, Lei T, Safavi-Abbasi S, et al. Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study. J Neurosurg. 2016;125(4):915–28.CrossRefGoogle Scholar
  11. 11.
    Romero FR, Fernandes ST, Chaddad-Neto F, Ramos JG, Campos JM, Oliveira E. Microsurgical techniques using human placenta. Arq Neuropsiquiatr. 2008;66(4):876–8.CrossRefGoogle Scholar
  12. 12.
    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; discussion 600–1.CrossRefGoogle Scholar
  13. 13.
    Belykh EG, Byval’tsev VA, Nakadzhi P, Lei T, Oliviero MM, Nikiforov SB. A model of the arterial aneurysm of the brain for microneurosurgical training. Zh Vopr Neirokhir Im N N Burdenko. 2014;78(2):40–5; discussion 5.Google Scholar
  14. 14.
    Oliveira MM, Araujo AB, Nicolato A, et al. Face, content, and construct validity of brain tumor microsurgery simulation using a human placenta model. Neurosurgery. 2015;12:61–7.Google Scholar
  15. 15.
    Belykh EG, Lei T, Oliveira MM, et al. Carotid endarterectomy surgical simulation model using a bovine placenta vessel. Neurosurgery. 2015;77(5):825–9; discussion 9–30.CrossRefGoogle Scholar
  16. 16.
    Marbacher S, Marjamaa J, Abdelhameed E, Hernesniemi J, Niemela M, Frosen J. The Helsinki rat microsurgical sidewall aneurysm model. J Vis Exp. 2014;92:e51071.Google Scholar
  17. 17.
    Aboud E, Aboud G, Al-Mefty O, et al. “Live cadavers” for training in the management of intraoperative aneurysmal rupture. J Neurosurg. 2015;123(5):1339–46.CrossRefGoogle Scholar
  18. 18.
    Olabe J, Olabe J, Sancho V. Human cadaver brain infusion model for neurosurgical training. Surg Neurol. 2009;72(6):700–2.CrossRefGoogle Scholar
  19. 19.
    Olabe J, Olabe J, Roda JM, Sancho V. Human cadaver brain infusion skull model for neurosurgical training. Surg Neurol Int. 2011;2:54.CrossRefGoogle Scholar
  20. 20.
    Russin JJ, Mack WJ, Carey JN, Minneti M, Giannotta SL. Simulation of a high-flow extracranial-intracranial bypass using a radial artery graft in a novel fresh tissue model. Neurosurgery. 2012;71(2 Suppl Operative):ons315–19; discussion ons 319–20.CrossRefGoogle Scholar
  21. 21.
    Shimizu S, Sekiguchi T, Mochizuki T, et al. Moist-condition training for cerebrovascular anastomosis: a practical step after mastering basic manipulations. Neurol Med Chir (Tokyo). 2015;55(8):689–92.CrossRefGoogle Scholar
  22. 22.
    Takeuchi M, Hayashi N, Hamada H, Matsumura N, Nishijo H, Endo S. A new training method to improve deep microsurgical skills using a mannequin head. Microsurgery. 2008;28(3):168–70.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Evgenii Belykh
    • 1
    • 2
  • Michael A. Bohl
    • 1
  • Kaith K. Almefty
    • 1
  • Mark C. Preul
    • 1
  • Peter Nakaji
    • 1
  1. 1.Department of NeurosurgeryBarrow Neurological Institute, St. Joseph’s Hospital and Medical CenterPhoenixUSA
  2. 2.Department of NeurosurgeryIrkutsk State Medical UniversityIrkutskRussia

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