The Hibiscus Model: A Feasible Cadaveric Model Using Continuous Arterial Circulation for Intracranial Bypass Training and Its Validation.

OBJECTIVE: The frequency of intracranial bypass procedures has declined. Thus it is difficult for neurosurgeons to develop the necessary skills for this complex procedure. We present a perfusion-based cadaveric model to provide a realistic training experience with high anatomic and physiological fidelity, as well as instantaneous assessment of bypass patency. Validation was assessed by evaluating the educational impact and skill improvement of the participants. METHODS: Fourteen participants attended a hands-on revascularization course with 7 cadaveric models connected to a continuous arterial circulation system pumping a red-colored solution through the entire cranial vasculature, mimicking blood circulation. The ability to perform a vascular anastomosis was evaluated initially. Further, a questionnaire on prior experience was provided. At the end of the 36-hour course, the ability to perform an intracranial bypass was reexamined and the participants completed a self-assessment questionnaire. RESULTS: Initially, only 3 attendees were able to perform an end-to-end anastomosis within the time limit, and only 2 of these anastomoses showed adequate patency. After having accomplished the course, all participants were able to complete a patent end-to-end anastomosis within the time limit, thus demonstrating a significant improvement. Further, both overall educational gain and surgical skills were regarded as remarkable (n = 11 and n = 9). CONCLUSIONS: Simulation-based education is considered an important aspect of medical and surgical development. The presented model is a feasible and accessible alternative to the prior models used for cerebral bypass training. This training may serve as a helpful and widely available tool to improve neurosurgeons' development irrespective of financial resources.

Importancia neuroquirúrgica del complejo venoso petroso superior / No disponible

Objetivo Conocer la anatomía microquirúrgica del complejo venoso petroso superior (CVPS).Material y métodos Se realizó estudio descriptivo y prospectivo. Se utilizaron 6 especímenes (12 lados) inyectados. Se estudió la anatomía microquirúrgica del CVPS en los encéfalos, mediante un abordaje retrosigmoideo y transpetroso anterior. Se utilizó instrumental neuroquirúrgico, endoscopio rígido de 0 grados, microscopio quirúrgico OPMI-1 con magnificación 6× a 20×. Se analizó el patrón de drenaje hacia el seno petroso superior, la formación de las venas tributarias, la relación con el nervio trigémino y las variantes del CVPS.Resultados El CVPS se encontró en todos los lados, la vena tributaria que se encontró en el 100% de los lados fue la vena de la fisura cerebelopontina. El patrón de drenaje del CVPS fue dividido en relación a la cresta suprameatal en: lateral, medial y en un punto intermedio. Se encontró el CVPS simple, formado por un tronco con sus tributarias, en 8 lados y duplicado en 4 lados. En el estudio se observó un triángulo formado por el tentorio, el CVPS y parte de la cara petrosa y tentorial del cerebelo con bordes y contenidos bien definidos, el cual se llamó triángulo petroso-tentorial. Conclusión Es necesario entender la anatomía microquirúrgica del CVPS. Así, proponemos el triángulo petroso-tentorial como corredor neuroquirúrgico para el manejo de lesiones del ángulo pontocerebeloso a la región petroclival superior (AU)

[Neurosurgical importance of the superior petrosal venous complex]. / Importancia neuroquirúrgica del complejo venoso petroso superior.

OBJECTIVE: To study the microsurgical anatomy of the superior petrosal venous complex (SPVC). MATERIAL AND METHODS: We conducted a descriptive and prospective study. Six injected specimens were used (12 sides). The microsurgical anatomy of the SPVC was studied by means of an anterior, retrosigmoid and transpetrosal approach. Neurosurgical equipment, 0-degree rigid endoscopy and OPMI-1 surgical microscope with 6× to 20× magnification were all used in this study. The venous drainage pattern toward the superior petrosal sinus was analysed, as were the formation of tributary veins, the relationship with the trigeminal nerve and the anatomical variants of SPVC. RESULTS: The SPVC was present in all cases. A tributary, cerebellopontine fissure vein was identified in 100% of cases. The venous drainage pattern of the SPVC was divided into medial, intermediate and lateral with respect to the suprameatal crest. The SPVC was simple in 8 sides and duplicate in 4 sides. A triangle formed by the tentorium, the SPVC and part of the tentorial and petrosal surface of the cerebellum was also observed in the study. This triangle was called the petrosal-tentorial triangle. CONCLUSIONS: It is important to understand the microsurgical anatomy of the SPVC. Therefore, we propose the petrosal-tentorial triangle as a neurosurgical route for the management of pathologies from the cerebellopontine angle to the superior petroclival region.