Artikel
Simple and reproducible neurovascular model for neurosurgical training of anastomoses
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Autoren
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Dino Podlesek
- Technische Universität Dresden, Universitätsklinikum Carl-Gustav Carus, Klinik und Poliklinik für Neurochirurgie
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Julia Kuß
- Technische Universität Dresden, Fakultät Elektrotechnik und Informationstechnik Institut für Biomedizinische Technik
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Marco Niesche
- Technische Universität Dresden, Universitätsklinikum Carl-Gustav Carus, Klinik und Poliklinik für Neurochirurgie
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Gabriele Schackert
- Technische Universität Dresden, Universitätsklinikum Carl-Gustav Carus, Klinik und Poliklinik für Neurochirurgie
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Matthias Kirsch
- Technische Universität Dresden, Universitätsklinikum Carl-Gustav Carus, Klinik und Poliklinik für Neurochirurgie
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: The aim of this study was to construct a simple, cheap and reproducible setup to model vascular anastomoses for neurosurgical training.
Method: Neurosurgical microinstruments and an operating theater with microscope were used for practicing the neurosurgical anastomosis of small vessels. Rabbit femoral arteries were strained within a box between opposite boards. The artificial liquid flow during the training was simulated by a peristaltic pump perfusing the vessel with stained physiologic sodium solution and with an ultrasound contrast agent. After inserting two arteries in perpendicular or parallel manner into the construct, end-to-side, side-to-side, and end-to-side anastomosis were practiced. Afterwards the plastic can was filled with either milk or gelatin to control anastomosis function by ultrasound.
Results: The time required for preparation and dismantling of the neurosurgical vascular model in the plastic can required usually less than 30 min. Any operating theater was suitable for this training purpose. The diameter of the rabbit arteries ranged from 1mm to 4mm in diameter. A rapid learning curve for students, residents and attendings alike (n=10) were seen, showing an increase in patency within 10 trials from <30% to >90%. Ultrasound imaging of the perfused vessel was only limited to low flow rates. Its use became apparent for all participants as soon as they mastered the imaging technique. Vessels of all diameters were accessible to US Doppler analysis. This highly reproducible model allowed to optimize ultrasound parameters and correlate these to conventional micro-Doppler assessments.
Conclusions: We demonstrated a reproducible and simple method for microvascular anastomosis training. Using this model various clinically relevant vascular scenarios can be modeled in this simple construct. Therefore, any mammal arteries can be used in this model. The ultrasound provided a real time control of the established anastomosis and trained its use for related intraoperative situations.
