CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2018; 37(S 01): S1-S332
DOI: 10.1055/s-0038-1673180
E-Poster – Vascular
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

STA-MCA bypass using ex vivo and synthetic hybrid model

Lucas Rodrigues de Souza
1   Hospital das Clínicas da UFMG
,
Marcelo Magaldi Ribeiro De Oliveira
1   Hospital das Clínicas da UFMG
,
Sebastião Nataniel Silva Gusmão
1   Hospital das Clínicas da UFMG
,
Carlos Eduardo Prata Fernandes Ferrarez
1   Hospital das Clínicas da UFMG
,
Emmanuel De Oliveira Sampaio Vasconcelos
1   Hospital das Clínicas da UFMG
,
Luiza Cançado Guerra D’Assumpção
1   Hospital das Clínicas da UFMG
,
Antonio Gilson Prates Júnior
1   Hospital das Clínicas da UFMG
,
Eduardo Dalla Bernardina Fraga
1   Hospital das Clínicas da UFMG
,
Fernando Augusto Medeiros Carrera Macedo
1   Hospital das Clínicas da UFMG
,
Henrique Dias De Souza
1   Hospital das Clínicas da UFMG
,
Taise Miriam Cruz Mosso Ramos
1   Hospital das Clínicas da UFMG
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Publikationsverlauf

Publikationsdatum:
06. September 2018 (online)

 

Introduction: Execution of cerebrovascular bypass requires the development of specific high complexity technical skills. The logic for creating vascular anastomosis training models is that this procedure is considered the most challenging in neurosurgery. Vascular bypass simulation models traditionally involve dead animals, e.g., chicken wing, livestock or synthetic templates.

Objective: Provide a microsurgical hybrid model for practice and improvement of the techniques reacquired for the Superficial Temporal Artery–Middle Cerebral Artery bypass using a 3D printed synthetic skull associated with human placentas. Methods Signed informed consent was obtained from pregnant women and screening prenatal infection was performed. After washing the placenta in running water, saline was injected into the vein and the two umbilical arteries to remove any clots within blood vessels. The allantoic membrane was removed to allow a better visualization of the vessels. The two arteries of the placenta were cannulated. After this preparation, one placenta was inserted into the skull, before placing itself the target vessel (simulated MCA) in the craniotomy area and the other positioned outside the skull (simulated STA). We invited 6 neurosurgeons with experience in microsurgery vascular (group Expert) and 6 residents in neurosurgery of the 3rd and 4th year (group Beginners) for the validation of the exercises. All were asked to perform a simulation of an end-to-side anastomosis (ATS-ACM).

Results: The similarities of microsurgical tasks for the ATS-ACM bypass surgical were evaluated. According to the opinion of experts and novices, the suggest model was not similar to all surgery, but the microsurgery tasks were very similar. The use of microsurgical instruments, microscope and the microsurgical handling of vessels were exactly as in real surgery. Microsurgical dissection of tissues was classified as very similar. The time required for complete the assignment was statistically different in the two groups. The novice group without any previous experience microsurgical had difficulty on all tasks.

Conclusion: Our results show the possibility to realize all main tasks and steps of the surgical procedure in question. It favors the pedagogical principle of progressive learning. The exercise may be well completed only after the proper execution of all tasks. The hybrid model proposed offer one singular training tool for ATS-ACM bypass surgeries, showing high fidelity and low cost.