====== Neurosurgical laboratory training model ====== A growing body of [[literature]] describing use of high-fidelity surgical [[training model]]s is challenging long-held dogma that [[cadaver]]s provide the best medium for [[postgraduate]] [[technical skills]] training. ---- A neurosurgical skills [[course]] for residents was structured to include 7 spinal and 3 cranial learning stations, each with its own model and assigned attending expert. Resident and attending neurosurgeons were asked to complete surveys on their overall impressions of the course and models, and on workload comparisons between models and real cases. Student t-tests were used for statistical comparisons. Survey responses were collected from 9 of 16 participating residents (56.3%) and 3 of 10 attending neurosurgeons (30.0%). Both groups believed the course was very helpful overall to resident education. Respondents furthermore felt the course was more helpful overall than cadaveric courses. Task load index testing revealed no significant workload difference between models and real cases (P≥0.17), except in temporal demand (P<0.001). Resident and attending neurosurgeons subjectively feel that high-fidelity synthetic models were superior to cadavers as a surgical skills teaching platform. This study raises the question of whether cadavers should remain the gold standard for surgical skills courses. Expanded use of these teaching models and further study are warranted ((Bohl MA, McBryan S, Spear C, Pais Hs D, Preul MC, Wilhelmi B, Yeskel A, Turner JD, Kakarla UK, Nakaji P. Evaluation of a novel surgical skills training course: are cadavers still the gold standard for surgical skills training? World Neurosurg. 2019 Mar 28. pii: S1878-8750(19)30910-6. doi: 10.1016/j.wneu.2019.03.230. [Epub ahead of print] PubMed PMID: 30930320. )). ---- A neurosurgical laboratory training model is designed for trainees in [[microneurosurgery]] to learn to handle [[surgical microscope]]s and [[microneurosurgical instruments]]. The silicone injection of a fresh cadaveric cow cranium is an alternative to using a cadaveric human brain for becoming familiar with the cerebellopontine angle (CPA) via the retrosigmoid approach. To report an improved method for training in the CPA via the retrosigmoid approach, using a fresh cadaveric cow cranium injected with silicone. The material consists of a [[cadaveric head]] cow brain injected with silicone. Preparation consists of irrigation of the major vessels followed by injection of silicone, coloured either red or blue. A three-step approach was designed to simulate microneurosurgical dissection along with the cerebellopontine angle and to dissect cranial nerves emerging from the brain stem. This laboratory training model is useful in allowing trainees to gain experience with the use of an operating microscope and familiarity with the CPA via the retrosigmoid approach. The aim of this study was to develop a novel model and to adapt it to create a life-like neurosurgical training system ((Turan Suslu H, Ceylan D, Tatarlı N, Hıcdonmez T, Seker A, Bahrı Y, Kılıc T. Laboratory training in the retrosigmoid approach using cadaveric silicone injected cow brain. Br J Neurosurg. 2013 Dec;27(6):812-4. doi: 10.3109/02688697.2013.772095. Epub 2013 Mar 4. PubMed PMID: 23458576.)). ---- In 2002 cadaveric heads were prepared for surgical procedures in the following manner: the carotid arteries (CAs) and vertebral arteries (VAs) in the neck were cannulated, as were the internal jugular veins (JVs) on both sides. Two tubes were introduced into the spinal canal and each one was advanced into one of the cerebellopontine angle cisterns. A CA, VA, or both were then connected to a reservoir containing light red fluid and a pressure of 80 to 120 mm Hg and a pulse rate of 60 beats/minute were established using a pump. The JV on the side currently being dissected was connected to a reservoir containing dark red fluid and kept at a pressure between 20 and 40 mm Hg. The remaining vessels were clamped in the neck. The cisternal tubes were connected to a reservoir of clear fluid that was regulated by an adjustable flow. Nine trainees have tested this model on eight specimens by practicing a variety of surgical procedures and maneuvers, including craniotomies; hemostasis; cisternal and vascular dissection; vascular anastomosis and repair; establishment of arterial bypasses; aneurysm creation, dissection, and clipping; management of an aneurysm rupture; intraparenchymal resection such as amygdalohippocampectomy; ventricular endoscopy and third ventriculostomy; cavernous sinus and skull base approaches; and resection of artificial tumors in the basal cisterns. This model mimics the normal human anatomy and dynamic vascular filling found in real surgery and presents it from the training perspective, allowing a wide range of skill development and repeated practice. It provides an alternative model to laboratory animals. It is inexpensive and readily available, and has great value for the acquisition and refinement of surgical skills that are not only specific to neurosurgery, but are applicable to other surgical disciplines ((Aboud E, Al-Mefty O, Yaşargil MG. New laboratory model for neurosurgical training that simulates live surgery. J Neurosurg. 2002 Dec;97(6):1367-72. PubMed PMID: 12507135. )).