Innovative real CSF leak simulation model for rhinology training: human cadaveric design
- 6 Downloads
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.
KeywordsCSF leak Simulation Training Rhinology Skull base Reconstruction
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.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 1.Weber RK, Hosemann W (2015) Comprehensive review on endonasal endoscopic sinus surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg Dec 22:14 Doc08Google Scholar
- 11.Zada G, Bakhsheshian J, Pham M, Minneti M, Christian E, Winer J et al (2017) Development of a perfusion-based cadaveric simulation model integrated into neurosurgical training: feasibility based on reconstitution of vascular and cerebrospinal fluid systems. Oper Neurosurg (Hagerstown)Google Scholar
- 12.Christian EA, Bakhsheshian J, Strickland BA, Fredrickson VL, Buchanan IA, Pham MH et al (2017) Perfusion-based human cadaveric specimen as a simulation training model in repairing cerebrospinal fluid leaks during endoscopic endonasal skull base surgery. J Neurosurg 3:1–5. https://doi.org/10.3171/2017.5.JNS162982 CrossRefGoogle Scholar