Seven bypasses simulation set: description and validity assessment of novel models for microneurosurgical training

Authors

Evgenii Belykh, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.Follow
Irakliy Abramov, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.Follow
Liudmila Bardonova, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.Follow
Ruchi Patel, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey; and.
Sarah McBryan, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Lara Enriquez Bouza, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Neil Majmundar, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Xiaochun Zhao, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Vadim A. Byvaltsev, Irkutsk State Medical University, Irkutsk, Russian Federation.
Stephen A. Johnson, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey; and.
Amit Singla, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey; and.
Gaurav Gupta, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey; and.
Hai Sun, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey; and.
James K. Liu, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey; and.
Anil Nanda, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey; and.
Mark C. Preul, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.Follow

Document Type

Article

Abstract

OBJECTIVE: Microsurgical training remains indispensable to master cerebrovascular bypass procedures, but simulation models for training that accurately replicate microanastomosis in narrow, deep-operating corridors are lacking. Seven simulation bypass scenarios were developed that included head models in various surgical positions with premade approaches, simulating the restrictions of the surgical corridors and hand positions for microvascular bypass training. This study describes these models and assesses their validity. METHODS: Simulation models were created using 3D printing of the skull with a designed craniotomy. Brain and external soft tissues were cast using a silicone molding technique from the clay-sculptured prototypes. The 7 simulation scenarios included: 1) temporal craniotomy for a superficial temporal artery (STA)-middle cerebral artery (MCA) bypass using the M4 branch of the MCA; 2) pterional craniotomy and transsylvian approach for STA-M2 bypass; 3) bifrontal craniotomy and interhemispheric approach for side-to-side bypass using the A3 branches of the anterior cerebral artery; 4) far lateral craniotomy and transcerebellomedullary approach for a posterior inferior cerebellar artery (PICA)-PICA bypass or 5) PICA reanastomosis; 6) orbitozygomatic craniotomy and transsylvian-subtemporal approach for a posterior cerebral artery bypass; and 7) extended retrosigmoid craniotomy and transcerebellopontine approach for an occipital artery-anterior inferior cerebellar artery bypass. Experienced neurosurgeons evaluated each model by practicing the aforementioned bypasses on the models. Face and content validities were assessed using the bypass participant survey. RESULTS: A workflow for model production was developed, and these models were used during microsurgical courses at 2 neurosurgical institutions. Each model is accompanied by a corresponding prototypical case and surgical video, creating a simulation scenario. Seven experienced cerebrovascular neurosurgeons practiced microvascular anastomoses on each of the models and completed surveys. They reported that actual anastomosis within a specific approach was well replicated by the models, and difficulty was comparable to that for real surgery, which confirms the face validity of the models. All experts stated that practice using these models may improve bypass technique, instrument handling, and surgical technique when applied to patients, confirming the content validity of the models. CONCLUSIONS: The 7 bypasses simulation set includes novel models that effectively simulate surgical scenarios of a bypass within distinct deep anatomical corridors, as well as hand and operator positions. These models use artificial materials, are reusable, and can be implemented for personal training and during microsurgical courses.

Medical Subject Headings

Humans; Cerebral Revascularization (methods); Craniotomy; Neurosurgical Procedures (methods); Brain; Skull

Publication Date

3-1-2023

Publication Title

Journal of neurosurgery

E-ISSN

1933-0693

Volume

138

Issue

3

First Page

732

Last Page

739

PubMed ID

35932275

Digital Object Identifier (DOI)

10.3171/2022.5.JNS22465

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