A Perfusion-Based Human Cadaveric Model for Management of Carotid Artery Injury during Endoscopic Endonasal Skull Base Surgery

Objectives: To create and develop a reproducible and realistic training environment to prepare residents and trainees for arterial catastrophes during endoscopic endonasal surgery.

Design: An artificial blood substitute was perfused at systolic blood pressures in eight fresh human cadavers to mimic intraoperative scenarios.

Setting: The USC Keck School of Medicine Fresh Tissue Dissection Laboratory was used as the training site.

Participants: Trainees were USC neurosurgery residents and junior faculty.

Main Outcome Measures: A 5-point questionnaire was used to assess pre- and post-training confidence scores.

Results: High-pressure extravasation at normal arterial blood pressure mimicked real intraoperative ICA injury. Residents developed psychomotor skills required to achieve hemostasis using suction, cottonoids, and muscle grafts. Questionnaire responses from all trainees reported a realistic experience enhanced by the addition of the perfusion model.

Conclusions: The addition of an arterial perfusion system to fresh tissue cadavers is among the most realistic training models available. This enables the simulation of rare intraoperative scenarios such as ICA injury. Strategies for rapid hemostasis and implementation of techniques including endoscope manipulation, suction, and packing can all be rehearsed via this novel paradigm.