A Practical Cadaveric Model for Intracranial Bypass Training.

Abstract:

BACKGROUND:Intracranial bypass is technically challenging and difficult to learn owing to its relative rarity and complexity. Although multiple training models for intracranial bypass exist, a detailed depiction of the use and fidelity of cadaveric specimens for bypass training is lacking in the literature. This study describes use of preserved cadaveric specimens as a practical training model for performance of multiple intracranial bypasses and discusses the surgical setup for a cadaveric bypass laboratory. METHODS:Using a cadaveric specimen and basic microneurosurgical instruments and supplies, 5 intracranial bypasses were performed (superficial temporal artery [STA]-to-middle cerebral artery [MCA], MCA-to-MCA, STA-to-posterior cerebral artery [PCA], anterior cerebral artery-to-anterior cerebral artery, and posterior inferior cerebellar artery-to-posterior inferior cerebellar artery) using pterional, subtemporal, interhemispheric, and suboccipital approach. Bypass integrity was assessed by direct fluid injection into the adjacent vessel segment. All procedures were recorded. RESULTS:Procedural steps mirrored actual bypass surgery and included vessel marking, performance of arteriotomy, and completion of an end-to-end, end-to-side, or side-to-side anastomosis. Simulations included anatomically appropriate exposures of common intracranial (MCA, PCA, posterior inferior cerebellar artery, anterior cerebral artery) and extracranial (STA) vessels encountered during cerebral bypass surgery and high-fidelity recreations of the operative corridors associated with deeper anastomoses, such as STA-to-PCA bypass. Vessel diameters were 1.5-2.1 mm, and anastomosis times were 20-40 minutes. Immediate feedback on anastomotic integrity was achieved via direct fluid injection adjacent to the anastomosis site. CONCLUSIONS:The cadaveric specimen trainee model is a relatively simple yet high-fidelity approach for learning intracranial bypass.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Steinberg JA,Rennert RC,Levy M,Khalessi AA

doi

10.1016/j.wneu.2018.09.170

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

e576-e583

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(18)32216-2

journal_volume

121

pub_type

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