title: "Live cadavers" for training in the management of intraoperative aneurysmal rupture.
abstract: OBJECTIVE
  Intraoperative rupture occurs in approximately 9.2% of all cranial aneurysm surgeries. This event is not merely a surgical complication, it is also a real surgical crisis that requires swift and decisive action. Neurosurgical residents may have little exposure to this event, but they may face it in their practice. Laboratory training would be invaluable for developing competency in addressing this crisis. In this study, the authors present the "live cadaver" model, which allows repetitive training under lifelike conditions for residents and other trainees to practice managing this crisis.
  
  
  METHODS
  The authors have used the live cadaver model in 13 training courses from 2009 to 2014 to train residents and neurosurgeons in the management of intraoperative aneurysmal rupture. Twenty-three cadaveric head specimens harboring 57 artificial and 2 real aneurysms were used in these courses. Specimens were specially prepared for this technique and connected to a pump that sent artificial blood into the vessels. This setting created a lifelike situation in the cadaver that simulates live surgery in terms of bleeding, pulsation, and softness of tissue.
  
  
  RESULTS
  A total of 203 neurosurgical residents and 89 neurosurgeons and faculty members have practiced and experienced the live cadaver model. Clipping of the aneurysm and management of an intraoperative rupture was first demonstrated by an instructor. Then, trainees worked for 20- to 30-minute sessions each, during which they practiced clipping and reconstruction techniques and managed intraoperative ruptures. Ninety-one of the participants (27 faculty members and 64 participants) completed a questionnaire to rate their personal experience with the model. Most either agreed or strongly agreed that the model was a valid simulation of the conditions of live surgery on cerebral aneurysms and represents a realistic simulation of aneurysmal clipping and intraoperative rupture. Actual performance improvement with this model will require detailed measurement for validating its effectiveness. The model lends itself to evaluation using precise performance measurements.
  
  
  CONCLUSIONS
  The live cadaver model presents a useful simulation of the conditions of live surgery for clipping cerebral aneurysms and managing intraoperative rupture. This model provides a means of practice and promotes team management of intraoperative cerebrovascular critical events. Precise metric measurement for evaluation of training performance improvement can be applied.
authors.affiliation: Arkansas Neuroscience Institute, St. Vincent Health System, Little Rock, Arkansas;
authors.forename: Emad
authors.initials: E
authors.lastname: Aboud
authors.affiliation: Atlantic University, School of Medicine, Island Park, New York;
authors.forename: Ghaith
authors.initials: G
authors.lastname: Aboud
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts;
authors.forename: Ossama
authors.initials: O
authors.lastname: Al-Mefty
authors.affiliation: Atlantic University, School of Medicine, Island Park, New York;
authors.forename: Talal
authors.initials: T
authors.lastname: Aboud
authors.affiliation: Arkansas Neuroscience Institute, St. Vincent Health System, Little Rock, Arkansas;
authors.forename: Stylianos
authors.initials: S
authors.lastname: Rammos
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts;|Department of Neurosurgery, Ain Sham University, Cairo, Egypt;
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abolfotoh
authors.affiliation: Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan;
authors.forename: Sanford P C
authors.initials: SP
authors.lastname: Hsu
authors.affiliation: International Neuroscience Institute, Hannover, Germany; and.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Koga
authors.affiliation: Semmes-Murphey Neurologic and Spine Institute, and Department of Neurosurgery, University of Tennessee, Memphis, Tennessee.
authors.forename: Adam
authors.initials: A
authors.lastname: Arthur
authors.affiliation: Arkansas Neuroscience Institute, St. Vincent Health System, Little Rock, Arkansas;
authors.forename: Ali
authors.initials: A
authors.lastname: Krisht
mesh_terms: D017542:Aneurysm, Ruptured / Q000209:etiology / Q000601:surgery*; D002102:Cadaver; D002983:Clinical Competence; D004521:Educational Measurement; D006801:Humans; D007396:Internship and Residency; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D007431:Intraoperative Complications / Q000601:surgery*; D009493:Neurosurgery / Q000193:education; D019635:Neurosurgical Procedures / Q000193:education*; D016544:Patient Simulation; D011795:Surveys and Questionnaires
keywords: MCA = middle cerebral artery; cerebral aneurysm; live cadaver; neurovascular; perfused cadaver; pulsatile model; surgical training