European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 4, pp 937–941 | Cite as

Innovative real CSF leak simulation model for rhinology training: human cadaveric design

  • Abdulaziz A. AlQahtani
  • Abeer A. Albathi
  • Othman M. Alhammad
  • Abdulkarim S. Alrabie



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.


CSF leak Simulation Training Rhinology Skull base Reconstruction 


Author contributions

Abdulaziz AlQahtani: Conception, design, data collection and writing the manuscript. Abeer Albathi: Design, data collection and writing the manuscript. Othman Alhammad: Design, data collection and writing the manuscript. Abdulkarim Alrabie: Design, data collection and writing the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Otorhinoraryngology/Head and Neck SurgeryPrince Sultan Military Medical CityRiyadhSaudi Arabia
  2. 2.Department of NeurosurgeryPrince Sultan Military Medical CityRiyadhSaudi Arabia

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