Cerebrovascular neurosurgeons must be proficient in microvascular operative techniques. Complex microvascular surgical skills are needed for the treatment of many cerebrovascular pathologies, including moyamoya disease, complex aneurysms, intracranial and extracranial stenosis of large vessels, and iatrogenic vascular injuries. Microvascular techniques should be developed before they are needed in the operating room so that neurosurgeons are prepared when presented with a cerebrovascular problem or emergency.
In this chapter, we describe basic biological models for neurosurgical training in microanastomosis, including poultry arteries, human and bovine placentas, rat vessels, and cadaveric material. We also provide information on appropriate laboratory setup. Biological microanastomosis training and experience should be an element in a comprehensive training program that proceeds in a graduated fashion, beginning first with training that uses dry materials, followed by “wet” training that uses biological simulation models, and finally culminating with surgery on living patients. Biological models can also serve as an effective means to keep infrequently used skills sharp and to practice new skills or innovative techniques before deploying them in patient care.
Results from the skills training and validation experiments discussed below, supplemented by insight from modern neurophysiological data, provide the background data necessary for developing an evidence-based microsurgical training paradigm. Numerous well-developed and validated biological models are available for microvascular anastomosis training. Microsurgical anastomosis practice should be implemented in all neurosurgical departments for the training of residents, fellows, and cerebrovascular attending staff.
Anastomosis Aneurysm Arteriovenous malformation Artery Biological model Bypass Chicken wing Microanastomosis Microsurgery Placenta Rat Stenosis Surgical training Turkey wing Vascular injury
Superficial Temporal Artery
Institutional Animal Care and Use Committee
This is a preview of subscription content, log in to check access.
The authors thank the Neuroscience Publications staff at Barrow Neurological Institute in Phoenix, Arizona, for their kind assistance in the preparation of this manuscript.
Krings T, Mandell DM, Kiehl TR, et al. Intracranial aneurysms: from vessel wall pathology to therapeutic approach. Nat Rev Neurol. 2011;7(10):547–59.CrossRefGoogle Scholar
Sun H, Safavi-Abbasi S, Spetzler RF. Retractorless surgery for intracranial aneurysms. J Neurosurg Sci. 2016;60(1):54–69.PubMedGoogle Scholar
Belykh E, Byvaltsev V. Off-the-job microsurgical training on dry models: Siberian experience. World Neurosurg. 2014;82(1–2):20–4.CrossRefGoogle Scholar
Kshettry VR, Mullin JP, Schlenk R, Recinos PF, Benzel EC. The role of laboratory dissection training in neurosurgical residency: results of a national survey. World Neurosurg. 2014;82(5):554–9.CrossRefGoogle Scholar
Abla AA, Uschold T, Preul MC, Zabramski JM. Comparative use of turkey and chicken wing brachial artery models for microvascular anastomosis training. J Neurosurg. 2011;115(6):1231–5.CrossRefGoogle Scholar
Hino A. Training in microvascular surgery using a chicken wing artery. Neurosurgery. 2003;52(6):1495–7; discussion 7–8.CrossRefGoogle Scholar
Colpan ME, Slavin KV, Amin-Hanjani S, Calderon-Arnuphi M, Charbel FT. Microvascular anastomosis training model based on a turkey neck with perfused arteries. Neurosurgery. 2008;62(5 Suppl 2):ONS407-10; discussion ONS10-1.CrossRefGoogle Scholar
Olabe J, Olabe J. Microsurgical training on an in vitro chicken wing infusion model. Surg Neurol. 2009;72(6):695–9.CrossRefGoogle Scholar
Jusue-Torres I, Sivakanthan S, Pinheiro-Neto CD, Gardner PA, Snyderman CH, Fernandez-Miranda JC. Chicken wing training model for endoscopic microsurgery. J Neurol Surg B Skull Base. 2013;74(5):286–91.CrossRefGoogle Scholar
Belykh E, Lei T, Safavi-Abbasi S, et al. Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study. J Neurosurg. 2016;125(4):915–28.CrossRefGoogle Scholar
Romero FR, Fernandes ST, Chaddad-Neto F, Ramos JG, Campos JM, Oliveira E. Microsurgical techniques using human placenta. Arq Neuropsiquiatr. 2008;66(4):876–8.CrossRefGoogle Scholar
Oliveira Magaldi M, Nicolato A, Godinho JV, et al. Human placenta aneurysm model for training neurosurgeons in vascular microsurgery. Neurosurgery. 2014;10(Suppl 4):592–600; discussion 600–1.CrossRefGoogle Scholar
Belykh EG, Byval’tsev VA, Nakadzhi P, Lei T, Oliviero MM, Nikiforov SB. A model of the arterial aneurysm of the brain for microneurosurgical training. Zh Vopr Neirokhir Im N N Burdenko. 2014;78(2):40–5; discussion 5.Google Scholar
Oliveira MM, Araujo AB, Nicolato A, et al. Face, content, and construct validity of brain tumor microsurgery simulation using a human placenta model. Neurosurgery. 2015;12:61–7.Google Scholar
Belykh EG, Lei T, Oliveira MM, et al. Carotid endarterectomy surgical simulation model using a bovine placenta vessel. Neurosurgery. 2015;77(5):825–9; discussion 9–30.CrossRefGoogle Scholar
Marbacher S, Marjamaa J, Abdelhameed E, Hernesniemi J, Niemela M, Frosen J. The Helsinki rat microsurgical sidewall aneurysm model. J Vis Exp. 2014;92:e51071.Google Scholar
Aboud E, Aboud G, Al-Mefty O, et al. “Live cadavers” for training in the management of intraoperative aneurysmal rupture. J Neurosurg. 2015;123(5):1339–46.CrossRefGoogle Scholar
Olabe J, Olabe J, Sancho V. Human cadaver brain infusion model for neurosurgical training. Surg Neurol. 2009;72(6):700–2.CrossRefGoogle Scholar
Olabe J, Olabe J, Roda JM, Sancho V. Human cadaver brain infusion skull model for neurosurgical training. Surg Neurol Int. 2011;2:54.CrossRefGoogle Scholar
Russin JJ, Mack WJ, Carey JN, Minneti M, Giannotta SL. Simulation of a high-flow extracranial-intracranial bypass using a radial artery graft in a novel fresh tissue model. Neurosurgery. 2012;71(2 Suppl Operative):ons315–19; discussion ons 319–20.CrossRefGoogle Scholar
Shimizu S, Sekiguchi T, Mochizuki T, et al. Moist-condition training for cerebrovascular anastomosis: a practical step after mastering basic manipulations. Neurol Med Chir (Tokyo). 2015;55(8):689–92.CrossRefGoogle Scholar
Takeuchi M, Hayashi N, Hamada H, Matsumura N, Nishijo H, Endo S. A new training method to improve deep microsurgical skills using a mannequin head. Microsurgery. 2008;28(3):168–70.CrossRefGoogle Scholar