AlQahtani Abdulaziz A, Albathi Abeer A, Alhammad Othman M, Alrabie Abdulkarim S
Department of Otorhinoraryngology/Head and Neck Surgery, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia.
Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Eur Arch Otorhinolaryngol. 2018 Apr;275(4):937-941. doi: 10.1007/s00405-018-4902-y. Epub 2018 Feb 12.
To study the feasibility of designing a human cadaveric simulation model of real CSF leak for rhinology training.
The laboratory investigation took place at the surgical academic center of Prince Sultan Military Medical City between 2016 and 2017. Five heads of human cadaveric specimens were cannulated into the intradural space through two frontal bone holes. Fluorescein-dyed fluid was injected intracranialy, then endoscopic endonasal iatrogenic skull base defect was created with observation of fluid leak, followed by skull base reconstruction. The outcome measures included subjective assessment of integrity of the design, the ability of creating real CSF leak in multiple site of skull base and the possibility of watertight closure by various surgical techniques.
The fluid filled the intradural space in all specimens without spontaneous leak from skull base or extra sinus areas. Successfully, we demonstrated fluid leak from all areas after iatrogenic defect in the cribriform plate, fovea ethmoidalis, planum sphenoidale sellar and clival regions. Watertight closure was achieved in all defects using different reconstruction techniques (overly, underlay and gasket seal closure).
The design is simulating the real patient with CSF leak. It has potential in the learning process of acquiring and maintaining the surgical skills of skull base reconstruction before direct involvement of the patient. This model needs further evaluation and competence measurement as training tools in rhinology training.
研究设计一种用于鼻科训练的真实脑脊液漏人体尸体模拟模型的可行性。
实验室研究于2016年至2017年在苏丹王子军事医疗城的外科医学中心进行。通过两个额骨孔将五具人类尸体标本的头部插管至硬膜内空间。向颅内注射荧光素染色液，然后在内镜下经鼻造成医源性颅底缺损并观察液体漏出情况，随后进行颅底重建。结果指标包括对设计完整性的主观评估、在颅底多个部位造成真实脑脊液漏的能力以及通过各种手术技术实现水密性闭合的可能性。
所有标本的硬膜内空间均充满液体，颅底或鼻窦外区域无自发漏液。成功地，我们在筛板、筛骨水平板、蝶鞍平面和斜坡区域医源性缺损后，证实了所有区域均有液体漏出。使用不同的重建技术（覆盖、衬垫和垫片密封闭合）对所有缺损均实现了水密性闭合。
该设计模拟了真实的脑脊液漏患者。在患者直接参与之前，它在获取和保持颅底重建手术技能的学习过程中具有潜力。作为鼻科训练的工具，该模型需要进一步评估和能力测量。
