Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Department of Neurological Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey.
World Neurosurg. 2020 Jun;138:39-51. doi: 10.1016/j.wneu.2020.02.107. Epub 2020 Feb 25.
Simulation models enable trainees to master microsurgical skills before performing surgeries. Vascular bypass is a critical component of cerebrovascular and many nonneurologic procedures. However, most available bypass training models lack important spatial, tactile, and physiologic aspects of real surgery. Animal and placental models provide true physiology but are expensive. While some models adequately simulate superficial temporal artery-middle cerebral artery bypass, there is no model for side-to-side distal anterior cerebral artery bypass. The objective is to create a realistic and inexpensive training model for this important procedure.
The depth of interhemispheric fissures in cadaver brains was compared with the grapefruit radii. Grapefruits were dissected to simulate the operative field within the deep and narrow interhemispheric fissure. Pericallosal arteries were mimicked with chicken wing vessels or synthetic tubing, with an aquarium pump providing closed circulation. Twelve board-certified neurosurgeons who were given bypass training using the grapefruit model were blindly surveyed on model realism and training suitability.
Grapefruit depths from pith to central column were comparable with interhemispheric cadaveric fissure depths. Approximate preparation time of grapefruit training models was 5-10 minutes. Surveyed neurosurgeons rated the model a better replicate for cerebral artery bypass (P < 0.02) and more challenging than common training models (P < 0.01). They also rated the grapefruit model as likely to be superior for improving surgical skills before surgery (P < 0.05).
This grapefruit model provides a realistic simulation of side-to-side distal anterior cerebral artery bypass procedure that can be inexpensively and easily implemented in nearly any resource environment.
模拟模型使受训者能够在进行手术之前掌握显微外科技能。血管旁路移植术是脑血管和许多非神经外科手术的关键组成部分。然而，大多数可用的旁路训练模型缺乏真实手术的重要空间、触觉和生理方面。动物和胎盘模型提供了真实的生理学，但价格昂贵。虽然有些模型充分模拟了颞浅动脉-大脑中动脉旁路移植术，但没有用于侧侧大脑前动脉旁路移植术的模型。本研究的目的是为这一重要手术创建一个现实且经济实惠的培训模型。
比较尸体大脑的大脑间裂深度与西柚的半径。将西柚切开，模拟在深而狭窄的大脑间裂内的手术区域。用鸡翅血管或合成管模拟大脑前动脉，用水族馆泵提供封闭循环。对使用西柚模型进行旁路培训的 12 名认证神经外科医生进行了模型真实性和培训适用性的盲目调查。
西柚从果心到中央柱的深度与大脑间尸体裂隙的深度相当。西柚训练模型的大致准备时间为 5-10 分钟。接受调查的神经外科医生认为该模型更能复制大脑动脉旁路移植术（P<0.02），比常见的训练模型更具挑战性（P<0.01）。他们还认为，在手术前提高手术技能方面，西柚模型可能更优越（P<0.05）。
这种西柚模型为侧侧大脑前动脉旁路移植术提供了一种现实的模拟，可以在几乎任何资源环境中经济、简便地实施。
