Coconut Model for Learning First Steps of Craniotomy Techniques and Cerebrospinal Fluid Leak Avoidance.
BACKGROUND
Neurosurgery simulation has gained attention recently due to changes in the medical system. First-year neurosurgical residents in low-income countries usually perform their first craniotomy on a real subject. Development of high-fidelity, cheap, and largely available simulators is a challenge in residency training. An original model for the first steps of craniotomy with cerebrospinal fluid leak avoidance practice using a coconut is described.


METHODS
The coconut is a drupe from Cocos nucifera L. (coconut tree). The green coconut has 4 layers, and some similarity can be seen between these layers and the human skull. The materials used in the simulation are the same as those used in the operating room.


METHODS
The coconut is placed on the head holder support with the face up. The burr holes are made until endocarp is reached. The mesocarp is dissected, and the conductor is passed from one hole to the other with the Gigli saw. The hook handle for the wire saw is positioned, and the mesocarp and endocarp are cut. After sawing the 4 margins, mesocarp is detached from endocarp. Four burr holes are made from endocarp to endosperm. Careful dissection of the endosperm is done, avoiding liquid albumen leak. The Gigli saw is passed through the trephine holes. Hooks are placed, and the endocarp is cut. After cutting the 4 margins, it is dissected from the endosperm and removed. The main goal of the procedure is to remove the endocarp without fluid leakage.


CONCLUSIONS
The coconut model for learning the first steps of craniotomy and cerebrospinal fluid leak avoidance has some limitations. It is more realistic while trying to remove the endocarp without damage to the endosperm. It is also cheap and can be widely used in low-income countries. However, the coconut does not have anatomic landmarks. The mesocarp makes the model less realistic because it has fibers that make the procedure more difficult and different from a real craniotomy.


CONCLUSIONS
The model has a potential pedagogic neurosurgical application for freshman residents before they perform a real craniotomy for the first time. Further validity is necessary to confirm this hypothesis.
Santa Casa da Misericórdia de Goiânia and Pontificial Catholic University of Goiás, Goiás, Brazil; Goiânia General Hospital, Goiás, Brazil; Federal University of Goiás, Goiás, Brazil. Electronic address: bernardodrummond@yahoo.com.br.
Bernardo
B
Drummond-Braga
Santa Casa da Misericórdia de Goiânia and Pontificial Catholic University of Goiás, Goiás, Brazil; Goiânia General Hospital, Goiás, Brazil.
Sebastião Berquó
SB
Peleja
Santa Casa da Misericórdia de Goiânia and Pontificial Catholic University of Goiás, Goiás, Brazil.
Guaracy
G
Macedo
Goiânia General Hospital, Goiás, Brazil.
Carlos Roberto S A
CR
Drummond
Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Pollyana H V
PH
Costa
Federal University of Goiás, Goiás, Brazil.
Marco T
MT
Garcia-Zapata
Federal University of Goiás, Goiás, Brazil; Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Marcelo Magaldi
MM
Oliveira
D065634:Cerebrospinal Fluid Leak / Q000517:prevention & control*; D003059:Cocos; D003399:Craniotomy / Q000379:methods*; D006801:Humans; D007858:Learning / Q000502:physiology*; D008953:Models, Anatomic
Coconut; Craniotomy; Doing more with less; Education; First craniotomy; First time; Neurosurgery residency; Neurosurgical simulation