Navigation-Guided Endoscopic Intraventricular Injectable Tumor Model: Cadaveric Tumor Resection Model for Neurosurgical Training.
BACKGROUND
Intraventricular tumors present difficult challenges to the neurosurgeon. Neurosurgeons have begun to explore the possibilities of using the endoscope in the radical resection of solid intraventricular lesions. There is a steep learning curve when dealing with such lesions with an endoscope.


OBJECTIVE
The aim of this study was to create a laboratory training model for neuroendoscopic surgery of intraventricular lesions guided by the navigation system. We believe this technique is more reliable than the traditional approach using contrast injection with C-arm x-ray guidance.


METHODS
Five formalin-fixated, latex-injected cadaveric heads were used. The arterial system was injected with red latex through the common carotid arteries, and the venous system was injected with blue latex through the internal jugular veins at the C6 vertebral level. The contrast-enhancing tumor polymer, Stratathane resin ST-504-derived polymer (SRSDP), was injected into the lateral ventricle via Frazier's point under direct endoscopic visualization and real-time neuronavigation guidance. When navigation was used for trajectory planning, the peel-away sheath was registered using a frameless navigational system (BrainLAB, Feldkirchen, Germany). A questionnaire was distributed to all participants in an endoscopic cadaveric course in which the models were used to evaluate the endoscopic tumor model.


RESULTS
Neurosurgeons participating in the course performed an endoscopic approach to resect the intraventricular tumor model through an ipsilateral frontal burr hole. The properties of the SRSDP mixture could be manipulated through varying concentrations of the materials used, in order to reach the desired consistency of a nodular solid lesion and possibility for piecemeal resection. The tumor model allowed participants to compare between normal and pathologic endoscopic anatomy in the same cadaveric head.


CONCLUSIONS
This injectable tumor model with the combination of neuroendoscopy and navigation can improve the accuracy of the endoscopic approach and minimize the risk of cadaveric brain specimen damage that in return augments the feeling of lifelike conditions. Using this endoscopic injectable tumor model technique can assist neurosurgeons' preparation for the challenges associated with an endoscopic piecemeal resection of a solid lesion in the lateral or third ventricle.
Department of Neurosurgery, St. Louis University, St. Louis, Missouri, USA.
Ahmed M
AM
Ashour
Department of Neurosurgery, St. Louis University, St. Louis, Missouri, USA.
Samer K
SK
Elbabaa
Department of Neurosurgery, George Washington University, Washington, District of Columbia, USA.
Anthony J
AJ
Caputy
Department of Neurosurgery, George Washington University, Washington, District of Columbia, USA. Electronic address: cristiang@email.gwu.edu.
Cristian
C
Gragnaniello
D002102:Cadaver; D002551:Cerebral Ventricle Neoplasms / Q000378:metabolism / Q000601:surgery*; D019723:Endoscopes; D006801:Humans; D020547:Lateral Ventricles / Q000601:surgery; D059032:Learning Curve; D008954:Models, Biological; D038361:Neuronavigation / Q000193:education / Q000379:methods*; D014696:Ventriculostomy / Q000193:education* / Q000379:methods*
Endoscopic tumor model; Endoscopy training; Tumor simulation