title: Cerebrospinal fluid reconstitution via a perfusion-based cadaveric model: feasibility study demonstrating surgical simulation of neuroendoscopic procedures.
abstract: Cadaveric surgical simulation carries the advantage of realistic anatomy and haptic feedback but has been historically difficult to model for intraventricular approaches given the need for active flow of CSF. This feasibility study was designed to simulate intraventricular neuroendoscopic approaches and techniques by reconstituting natural CSF flow in a cadaveric model. In 10 fresh human cadavers, a simple cervical laminectomy and dural opening were made, and a 12-gauge arterial catheter was introduced. Saline was continuously perfused at physiological CSF pressures to reconstitute the subarachnoid space and ventricles. A neuroendoscope was subsequently inserted via a standard right frontal bur hole. In 8 of the 10 cadavers, adequate reconstitution and endoscopic access of the lateral and third ventricles were achieved. In 2 cadavers, ventricular access was not feasible, perhaps because of a small ventricle size and/or deteriorated tissue quality. In all 8 cadavers with successful CSF flow reconstitution and endoscopic access, identifying the foramen of Monro was possible, as was performing septum pellucidotomy and endoscopic third ventriculostomy. Furthermore, navigation of the cerebral aqueduct, fourth ventricle, prepontine cistern, and suprasellar cistern via the lamina terminalis was possible, providing a complementary educational paradigm for resident education that cannot typically be performed in live surgery. Surgical simulation plays a critical and increasingly prominent role in surgical education, particularly for techniques with steep learning curves including intraventricular neuroendoscopic procedures. This novel model provides feasible and realistic surgical simulation of neuroendoscopic intraventricular procedures and approaches.
authors: Departments of 1 Neurosurgery and.
authors: Jesse L
authors: JL
authors: Winer
authors: Departments of 1 Neurosurgery and.
authors: Daniel R
authors: DR
authors: Kramer
authors: Departments of 1 Neurosurgery and.
authors: Richard A
authors: RA
authors: Robison
authors: Departments of 1 Neurosurgery and.
authors: Ifije
authors: I
authors: Ohiorhenuan
authors: General Surgery, University of Southern California, Los Angeles, California.
authors: Michael
authors: M
authors: Minneti
authors: Departments of 1 Neurosurgery and.
authors: Steven
authors: S
authors: Giannotta
authors: Departments of 1 Neurosurgery and.
authors: Gabriel
authors: G
authors: Zada
mesh_terms: D002102:Cadaver; D002552:Cerebral Ventricles / Q000033:anatomy & histology / Q000601:surgery; D002555:Cerebrospinal Fluid / Q000737:chemistry*; D002983:Clinical Competence; D004388:Dura Mater / Q000033:anatomy & histology / Q000601:surgery; D005240:Feasibility Studies; D006801:Humans; D007031:Hypothalamus / Q000033:anatomy & histology / Q000601:surgery; D007796:Laminectomy; D059032:Learning Curve; D044583:Neuroendoscopy / Q000193:education / Q000379:methods*; D038361:Neuronavigation / Q000193:education / Q000379:methods*; D019635:Neurosurgical Procedures / Q000193:education / Q000379:methods*; D012688:Septum Pellucidum / Q000033:anatomy & histology / Q000601:surgery; D014696:Ventriculostomy / Q000379:methods
keywords: ETV = endoscopic third ventriculostomy; FTDL = Fresh Tissue Dissection Laboratory; USC = University of Southern California; cadaver; cerebrospinal fluid; endoscopy; simulation; surgical technique; surgical training; third ventriculostomy