title: A Perfusion-based Human Cadaveric Model for Management of Carotid Artery Injury during Endoscopic Endonasal Skull Base Surgery.
abstract: Objective To create and develop a reproducible and realistic training environment to prepare residents and trainees for arterial catastrophes during endoscopic endonasal surgery. Design An artificial blood substitute was perfused at systolic blood pressures in eight fresh human cadavers to mimic intraoperative scenarios. Setting The USC Keck School of Medicine Fresh Tissue Dissection Laboratory was used as the training site. Participants Trainees were USC neurosurgery residents and junior faculty. Main Outcome A 5-point questionnaire was used to assess pre- and posttraining confidence scores. Results High-pressure extravasation at normal arterial blood pressure mimicked real intraoperative internal carotid artery (ICA) injury. Residents developed psychomotor skills required to achieve hemostasis using suction, cottonoids, and muscle grafts. Questionnaire responses from all trainees reported a realistic experience enhanced by the addition of the perfusion model. Conclusions The addition of an arterial perfusion system to fresh tissue cadavers is among the most realistic training models available. This enables the simulation of rare intraoperative scenarios such as ICA injury. Strategies for rapid hemostasis and implementation of techniques including endoscope manipulation, suction, and packing can all be rehearsed via this novel paradigm.
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, Los Angeles, California, United States.
authors.forename: Martin
authors.initials: M
authors.lastname: Pham
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, Los Angeles, California, United States.
authors.forename: Aydemir
authors.initials: A
authors.lastname: Kale
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, Los Angeles, California, United States.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Marquez
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, Los Angeles, California, United States.
authors.forename: Jesse
authors.initials: J
authors.lastname: Winer
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, Los Angeles, California, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, Los Angeles, California, United States.
authors.forename: Brianna
authors.initials: B
authors.lastname: Harris
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, Los Angeles, California, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Minnetti
authors.affiliation: Division of Plastic Surgery, Keck School of Medicine, Los Angeles, California, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Carey
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, Los Angeles, California, United States.
authors.forename: Steven
authors.initials: S
authors.lastname: Giannotta
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, Los Angeles, California, United States.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Zada
keywords: endoscopic skull base surgery; internal carotid artery; resident training; simulation; transsphenoidal