title: Endoscopic Management of Cavernous Carotid Surgical Complications: Evaluation of a Simulated Perfusion Model.
abstract: OBJECTIVE
  Endoscopic surgical treatment of pituitary tumors, lateral invading tumors, or aneurysms requires surgeons to operate adjacent to the cavernous sinus. During these endoscopic endonasal procedures, the carotid artery is vulnerable to surgical injury at its genu. The objective of this simulation model was to evaluate trainees regarding management of a potentially life-threatening vascular injury.
  
  
  METHODS
  Cadaveric heads were prepared in accordance with the Oregon Health & Science University body donation program. An endoscopic endonasal approach was used, and a perfusion pump with a catheter was placed in the ipsilateral common carotid artery at its origin in the neck. Learners used a muscle graft to establish vascular control and were evaluated over 3 training sessions. Simulation assessment, blood loss during sessions, and performance metric data were collected for learners.
  
  
  RESULTS
  Vascular control was obtained at a mean arterial pressure of 65 mm Hg using a muscle graft correctly positioned at the arteriotomy site. Learners improved over the course of training, with senior residents (n = 4) performing better across all simulation categories (situation awareness, decision making, communications and teamwork, and leadership); the largest mean difference was in communication and teamwork. Additionally, learner performance concerning blood loss improved between sessions (t = 3.667, P < 0.01).
  
  
  CONCLUSIONS
  In this pilot endoscopic endonasal simulation study, we successfully demonstrate a vascular complication perfusion model. Learners were able to gain direct applicable expertise in endoscopic endonasal techniques, instrumentation use, and teamwork required to optimize the technique. Learners gained skills of vascular complication management that transcend this model.
authors.affiliation: Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA. Electronic address: ciporen@ohsu.edu.
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Ciporen
authors.affiliation: Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Lucke-Wold
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Mendez
authors.affiliation: Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Cameron
authors.affiliation: Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Shirley
authors.initials: S
authors.lastname: McCartney
mesh_terms: D002102:Cadaver; D002343:Carotid Artery, Internal / Q000473:pathology / Q000601:surgery*; D002426:Cavernous Sinus / Q000473:pathology / Q000601:surgery*; D002983:Clinical Competence / Q000592:standards; D019468:Disease Management; D004724:Endoscopy / Q000379:methods / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards; D019635:Neurosurgical Procedures / Q000379:methods / Q000592:standards*; D010477:Perfusion / Q000379:methods / Q000592:standards*; D010865:Pilot Projects
keywords: Cadaver; Carotid vascular complication; Cost-effectiveness; Endoscopic endonasal approach; Reproducibility; Simulated training