开发和验证新型人体固定尸体模型,再现脑脊液循环,用于模拟内窥镜颅底手术。

IF 1.7 4区 医学 Q3 CLINICAL NEUROLOGY Operative Neurosurgery Pub Date : 2025-02-01 Epub Date: 2024-07-12 DOI:10.1227/ons.0000000000001272
Laura-Elisabeth Gosselin, Nicolas Morin, Charles Gariépy, Mathieu Chamberland, Olivier Beaulieu, Sylvie Nadeau, Pierre-Olivier Champagne
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引用次数: 0

摘要

背景和目的:内窥镜鼻内手术是一种行之有效的颅底手术方法。外科医生需要一种可重复使用的长效工具来掌握颅底重建所需的技能。本研究的目的是制作并验证一个人体福尔马林固定尸体模型,该模型能再现逼真的脑脊液(CSF)循环,并能充分再现 CSF 泄漏:方法:在蛛网膜下腔放置一个与蠕动泵连接的外置心室引流管,使水循环再现 CSF 循环。实时测量颅内压。进行内窥镜颅底探查,以创建不同的颅底开口和 CSF 漏点。参与者的任务是使用标准化的多层方法重建缺损,目标是在正常颅内压范围内获得不漏水的闭合。收集的数据包括重建时间、参与者的经验年限以及实现水密性重建的成功/失败率。此外还采用了李克特问卷调查法:结果:尸体模型再现了四种硬脑膜缺损类型的 CSF 循环:蝶窦、蝶鞍上、经蝶窦和经蝶窦。颅内压与生理条件相似,且具有再现性。每个模型都经过数月的多次测试。成功率与训练水平一致(r = 0.8282,P = 0.0017)。经验年限与重建时间之间也存在很强的反相关性(r = 0.4977,P < 0.0001)。参与者一致认为模型逼真(Likert 评分中位数为 4 分),并强烈认为模型有助于提高他们的手术技能(Likert 评分中位数为 5 分):结论:这种新颖的人体固定尸体 CSF 循环模型效率高,能充分再现颅底入路的手术条件。该模型独特、易于复制且可重复使用。它可用作教学和研究工具。
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Development and Validation of a Novel Human-Fixed Cadaveric Model Reproducing Cerebrospinal Fluid Circulation for Simulation of Endoscopic Endonasal Skull Base Surgery.

Background and objectives: Endoscopic endonasal surgery is a well-established surgical approach to the skull base. Surgeons need a reusable long-lasting tool to acquire the skills needed for skull base reconstruction. The aim of this study was to elaborate and validate a human formalin-fixed cadaveric model that reproduces a realistic cerebrospinal fluid (CSF) circulation and that adequately renders a CSF leak.

Methods: An external ventricular drain that connects with a peristaltic pump is placed in the subarachnoid space, which allows a water circulation that reproduces CSF circulation. Intracranial pressure is measured in real time. Endoscopic endonasal skull base approaches are performed, to create different skull base openings and CSF leaks. Participants were tasked with reconstruction of the defects using a standardized multilayered approach, with the goal of obtaining a watertight closure under normal intracranial pressure ranges. Compiled data included time of reconstruction, years of experience of participants, and success/failure to achieve a watertight reconstruction. A Likert questionnaire was also used.

Results: The cadaveric model reproduced CSF circulation in 4 types of dural defects: sellar, suprasellar, transcribriform, and transclival. Intracranial pressures were similar to physiological conditions and were reproducible. Each model was tested multiple times, over several months. Success rates concurred with training levels (r = .8282 and P = .0017). A strong inverse correlation was also found between years of experience and time of reconstruction (r = .4977 and P < .0001). Participants agreed that the model was realistic (median Likert score of 4), and they strongly agreed that it allowed for the improvement of their surgical skills (median Likert score of 5).

Conclusion: This novel human-fixed cadaveric model for CSF circulation is efficient and adequately reproduces surgical conditions for skull base approaches. The model is unique, easy to reproduce, and reusable. It can be used as a tool for teaching and for research purposes.

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来源期刊
Operative Neurosurgery
Operative Neurosurgery Medicine-Neurology (clinical)
CiteScore
3.10
自引率
13.00%
发文量
530
期刊介绍: Operative Neurosurgery is a bi-monthly, unique publication focusing exclusively on surgical technique and devices, providing practical, skill-enhancing guidance to its readers. Complementing the clinical and research studies published in Neurosurgery, Operative Neurosurgery brings the reader technical material that highlights operative procedures, anatomy, instrumentation, devices, and technology. Operative Neurosurgery is the practical resource for cutting-edge material that brings the surgeon the most up to date literature on operative practice and technique
期刊最新文献
Letter: The Role of Watertight Dural Closure in Supratentorial Craniotomy: A Systematic Review and Meta-Analysis. In Reply: The Role of Watertight Dural Closure in Supratentorial Craniotomy: A Systematic Review and Meta-Analysis. Treatment of Recurrent, Twice Coiled, Previously Ruptured Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery Aneurysm With Excision and End-to-End Anastomosis: 2-Dimensional Operative Video. Microsurgical Clip Ligation of a Large Anterior Communicating Artery Aneurysm Previously Treated With Woven Endobridge Device: 2-Dimensional Operative Video. A Cadaveric Feasibility Study of the Biportal Endoscopic Transfrontal Sinus Approach: A Minimally Invasive Approach to the Anterior Cranial Fossa.
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