Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0044-1787091
Research Article

Training in Sylvian Arachnoid Dissection: The Art of Using Kamiyama Scissors and a Simple Novel Model for Practice Sylvian Arachnoid Dissection Using Cotton Fiber with Brain Model

Chanon Ariyaprakai
1   Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
2   Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
,
Muhammad Kusdiansah
2   Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
3   Department of Neurosurgery National Brain Center, East Jakarta City, Indonesia
,
Javier Degollado-García
2   Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
4   Division of Neurovascular Surgery, Department of Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez Hospital, Mexico City, Mexico
,
Nakao Ota
2   Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
,
Kosumo Noda
2   Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
,
Hiroyasu Kamiyama
2   Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
,
Rokuya Tanikawa
2   Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Background Transsylvian approach is one of the main approaches for a variety of vascular, tumor, and skull-base lesions. Sylvian fissure harbors a lot of critical structures including the middle cerebral artery and many venous structures. If not done properly, the transsylvian approach could cause several complications. Up to now, there is no simple training model for practicing Sylvian fissure dissection. In this article, we describe the technique of using microscissors for the sharp dissection of arachnoid trabeculae. We also propose a new model for practicing Sylvian arachnoid dissection using a three-dimensional (3D) brain model with cotton fiber.

Method We inserted cotton fiber into the Sylvian fissure of the brain model (aneurysm box from UpsurgeOn) and covered the Sylvian fissure with a cotton sheet, then sprayed the water over it. We dissected this model under a microscope by using Kamiyama scissors in the right hand and suction in the left hand.

Result Under the microscope, our model appears comparable with the real Sylvian fissure. We can use this model for practicing arachnoid dissection with Kamiyama scissors.

Conclusion The arachnoid dissection model by using a 3D brain model with cotton fiber is a simplified and novel approach for practicing the Sylvian fissure dissection.

Keywords

sharp dissection of arachnoid - transsylvian approach - Kamiyama microscissors - practice arachnoid dissection - cotton fiber - brain model


Publication History

Article published online:
03 June 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • Reference

  • 1 Kazumata K, Yokoyama Y, Sugiyama T. et al. Anatomic consideration for transsylvian approach. Jpn J Neurosurg 2012; 21 (09) 680-687
    CrossrefGoogle Scholar
  • 2 Tanikawa R, Sugimura T, Hokari M. et al. Surgery of internal carotid aneurysms in distal transsylvian approach: differences and advantages of distal transsylvian approach. Nosotchu No Geka 2004; 32 (01) 19-24
    Google Scholar
  • 3 Ishikawa K, Sasaki T, Yamazaki T. et al. Surgical technique of proximal control in the middle cerebral artery aneurysm clipping by distal Sylvian approach in relation to the morphological variety of M1 segment. Nosotchu No Geka 2022; 50 (01) 25-30
    Google Scholar
  • 4 Nathal E, Serrano-Rubio A, Monroy-Sosa A. et al. Operative considerations and surgical treatment of sylvian fissure arteriovenous malformations: a 20-year experience. Neurosurg Focus 2022; 53 (01) E10
    CrossrefPubMedGoogle Scholar
  • 5 Kawaguchi T, Fujita S, Shose Y, Hamano S, Tanimoto A. Surgical strategy for sylvian fissure arteriovenous malformations. Nosotchu No Geka 1993; 21 (06) 455-459
    Google Scholar
  • 6 Safaee MM, Englot DJ, Han SJ, Lawton MT, Berger MS. The transsylvian approach for resection of insular gliomas: technical nuances of splitting the Sylvian fissure. J Neurooncol 2016; 130 (02) 283-287
    CrossrefPubMedGoogle Scholar
  • 7 Pitskhelauri D, Bykanov A, Konovalov A. et al. Transsylvian insular glioma surgery: new classification system, clinical outcome in a consecutive series of 79 cases. Oper Neurosurg (Hagerstown) 2021; 20 (06) 541-548
    CrossrefPubMedGoogle Scholar
  • 8 Tanikawa R, Wada H, Ishizaki T. et al. Anterior temporal approach for basilar bifurcation aneurysms as a modified distal transsylvian approach. Nosotchu No Geka 1998; 26 (04) 259-264
    Google Scholar
  • 9 Muhammad S, Tanikawa R, Lawton M, Regli L, Niemelä M, Korja M. Microsurgical dissection of Sylvian fissure-short technical videos of third generation cerebrovascular neurosurgeons. Acta Neurochir (Wien) 2019; 161 (09) 1743-1746
    CrossrefPubMedGoogle Scholar
  • 10 Rodríguez RG, Agyemang K, Arias SAM, Cearns MD, Chaddad-Neto F. Importance of arachnoid dissection in arteriovenous malformation microsurgery: a technical note. World Neurosurg 2023; 173: 12
    CrossrefPubMedGoogle Scholar
  • 11 Figueiredo EG, Deshmukh P, Zabramski JM, Preul MC, Crawford NR, Spetzler RF. The pterional-transsylvian approach: an analytical study. Neurosurgery 2008; 62 (6, suppl 3): 1361-1367
    CrossrefPubMedGoogle Scholar
  • 12 Maekawa H, Hadeishi H. Venous-preserving Sylvian dissection. World Neurosurg 2015; 84 (06) 2043-2052
    CrossrefPubMedGoogle Scholar
  • 13 Cohen-Gadol AA. Atraumatic Sylvian fissure split: nuances and pitfalls. Oper Neurosurg (Hagerstown) 2020; 18 (02) 217-224
    CrossrefPubMedGoogle Scholar
  • 14 Kageyama Y, Fukuda K, Kobayashi S. et al. Cerebral vein disorders and postoperative brain damage associated with the pterional approach in aneurysm surgery. Neurol Med Chir (Tokyo) 1992; 32 (10) 733-738
    CrossrefPubMedGoogle Scholar
  • 15 Gao W, Li Z, Zhang L. Surgical techniques and prevention of complications in the treatment of basal ganglia hemorrhage through the distal transsylvian approach. J Craniofac Surg 2020; 31 (01) e27-e30
    CrossrefPubMedGoogle Scholar
  • 16 Dean BL, Wallace RC, Zabramski JM, Pitt AM, Bird CR, Spetzler RF. Incidence of superficial sylvian vein compromise and postoperative effects on CT imaging after surgical clipping of middle cerebral artery aneurysms. AJNR Am J Neuroradiol 2005; 26 (08) 2019-2026
    PubMedGoogle Scholar
  • 17 Kazumata K, Kamiyama H, Ishikawa T. et al. Operative anatomy and classification of the sylvian veins for the distal transsylvian approach. Neurol Med Chir (Tokyo) 2003; 43 (09) 427-433 , discussion 434
    CrossrefPubMedGoogle Scholar
  • 18 Rey-Dios R, Cohen-Gadol AA. Technical nuances for surgery of insular gliomas: lessons learned. Neurosurg Focus 2013; 34 (02) E6
    CrossrefPubMedGoogle Scholar
  • 19 Moroi J, Ishikawa T, Hadeishi H, Kobayashi N, Suzuki A, Yasui N. Usefulness and safety of a distal transsylvian approach for microsurgical training. Nosotchu No Geka 2009; 37 (06) 429-433
    Google Scholar
  • 20 Stienen MN, Freyschlag CF, Schaller K, Meling T. EANS Young Neurosurgeons and EANS Training Committee. Procedures performed during neurosurgery residency in Europe. Acta Neurochir (Wien) 2020; 162 (10) 2303-2311
    CrossrefPubMedGoogle Scholar
  • 21 Hopkins B, Shlobin N, Kesavabhotla K, Smith Z, Dahdaleh N. Case volume analysis of neurological surgery training programs in the United States. . 2017–2019. Neurosurgery 2020 (e-pub ahead of print). doi: 67. 10.1093/neuros/nyaa447_140
    Google Scholar
  • 22 Guan J, Karsy M, Brock AA. et al. Impact of a more restrictive overlapping surgery policy: an analysis of pre- and postimplementation complication rates, resident involvement, and surgical wait times at a high-volume neurosurgical department. J Neurosurg 2018; 129 (02) 515-523
    CrossrefPubMedGoogle Scholar
  • 23 Woodrow SI, Bernstein M, Wallace MC. Safety of intracranial aneurysm surgery performed in a postgraduate training program: implications for training. J Neurosurg 2005; 102 (04) 616-621
    CrossrefPubMedGoogle Scholar
  • 24 Nguyen AV, Coggins WS, Jain RR. et al. Effect of an additional neurosurgical resident on procedure length, operating room time, estimated blood loss, and post-operative length-of-stay. Br J Neurosurg 2020; 34 (06) 611-615
    CrossrefPubMedGoogle Scholar
  • 25 Chawla S, Devi S, Calvachi P, Gormley WB, Rueda-Esteban R. Evaluation of simulation models in neurosurgical training according to face, content, and construct validity: a systematic review. Acta Neurochir (Wien) 2022; 164 (04) 947-966
    CrossrefPubMedGoogle Scholar
  • 26 Harada K, Morita A, Minakawa Y. et al. Assessing microneurosurgical skill with medico-engineering technology. World Neurosurg 2015; 84 (04) 964-971
    CrossrefPubMedGoogle Scholar
  • 27 Lizana J, Montemurro N, Aliaga N, Marani W, Tanikawa R. From textbook to patient: a practical guide to train the end-to-side microvascular anastomosis. Br J Neurosurg 2023; 37 (01) 116-120
    CrossrefPubMedGoogle Scholar
  • 28 Byvaltsev VA, Akshulakov SK, Polkin RA. et al. Microvascular anastomosis training in neurosurgery: a review. Minim Invasive Surg 2018; 2018: 6130286
    PubMedGoogle Scholar
  • 29 Altun A, Çokluk C. The microneurosurgical training model for intrinsic and extrinsic brain tumor surgery using polyurethane foam and fresh cadaveric cow brain: an experimental study. World Neurosurg X 2019; 4: 100039
    CrossrefPubMedGoogle Scholar
  • 30 Kamp MA, Knipps J, Steiger HJ. et al. Training for brain tumour resection: a realistic model with easy accessibility. Acta Neurochir (Wien) 2015; 157 (11) 1975-1981 , discussion 1981
    CrossrefPubMedGoogle Scholar
  • 31 Frithioff A, Frendø M, Pedersen DB, Sørensen MS, Wuyts Andersen SA. 3D-printed models for temporal bone surgical training: a systematic review. Otolaryngol Head Neck Surg 2021; 165 (05) 617-625
    CrossrefPubMedGoogle Scholar
  • 32 Gökyar A, Cokluk C. Using of fresh cadaveric cow brain in the microsurgical training model for sulcal-cisternal and fissural dissection. J Neurosci Rural Pract 2018; 9 (01) 26-29
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Tayebi Meybodi A, Borba Moreira L, Gandhi S, Preul MC, Lawton MT. Sylvian fissure splitting revisited: applied arachnoidal anatomy and proposition of a live practice model. J Clin Neurosci 2019; 61: 235-242
    CrossrefPubMedGoogle Scholar
  • 34 de Oliveira MMR, Ferrarez CE, Ramos TM. et al. Learning brain aneurysm microsurgical skills in a human placenta model: predictive validity. J Neurosurg 2018; 128 (03) 846-852
    CrossrefPubMedGoogle Scholar
  • 35 Blohm JE, Salinas PA, Avila MJ, Barber SR, Weinand ME, Dumont TM. Three-dimensional printing in neurosurgery residency training: a systematic review of the literature. World Neurosurg 2022; 161: 111-122
    CrossrefPubMedGoogle Scholar