A Perfusion-based Human Cadaveric Model for Management of Carotid Artery Injury during Endoscopic Endonasal Skull Base Surgery

Martin Pham, Aydemir Kale, Yvette Marquez, Jesse Winer, Brian Lee, Brianna Harris, Michael Minnetti, Joseph Carey, Steven Giannotta, Gabriel Zada

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Objective To create and develop a reproducible and realistic training environment to prepare residents and trainees for arterial catastrophes during endoscopic endonasal surgery. Design An artificial blood substitute was perfused at systolic blood pressures in eight fresh human cadavers to mimic intraoperative scenarios. Setting The USC Keck School of Medicine Fresh Tissue Dissection Laboratory was used as the training site. Participants Trainees were USC neurosurgery residents and junior faculty. Main Outcome A 5-point questionnaire was used to assess pre- and posttraining confidence scores. Results High-pressure extravasation at normal arterial blood pressure mimicked real intraoperative internal carotid artery (ICA) injury. Residents developed psychomotor skills required to achieve hemostasis using suction, cottonoids, and muscle grafts. Questionnaire responses from all trainees reported a realistic experience enhanced by the addition of the perfusion model. Conclusions The addition of an arterial perfusion system to fresh tissue cadavers is among the most realistic training models available. This enables the simulation of rare intraoperative scenarios such as ICA injury. Strategies for rapid hemostasis and implementation of techniques including endoscope manipulation, suction, and packing can all be rehearsed via this novel paradigm.

Original languageEnglish (US)
Pages (from-to)309-313
Number of pages5
JournalJournal of Neurological Surgery, Part B: Skull Base
Volume75
Issue number5
DOIs
StatePublished - May 2 2014
Externally publishedYes

Keywords

  • endoscopic skull base surgery
  • internal carotid artery
  • resident training
  • simulation
  • transsphenoidal

ASJC Scopus subject areas

  • Clinical Neurology

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