Artificial Cerebrospinal Fluid Circulation in Cadaver: Breakthrough in Neuroendoscopy Skill Learning

Fig. 1 CSF-created draining through ventriculostomy tube.

Fig. 2 Endoscopic view of ventricle with CSF.

Fig. 3 Well-preserved cerebral parenchyma—an endoscopic view.

Fig. 4 Well-preserved life-like cerebral parenchyma and blood vessels.

Background: When the surgical skills involved are complex with a steep learning curve, prior experience with surgical equipment and rehearsed navigation of the operative anatomy are mandatory. Neuroendoscopic approaches to skull base and intraventricular pathology are extremely difficult to model using only virtual reality. Formalin cadavers are not suitable, as there is no CSF circulating and cadaver is rigid and colorless. We designed special, nonformalin soft embalming fluid to preserve cadavers and also infused saline in ventricle system mimicking life like situation in ventriculoscopy skill learning.

Methods: Fresh cadavers received on voluntary body donation are deep freezed, and day before workshop the cadavers are embalmed with special soft embalming fluid, which preserves the cadaver almost life like. Then saline was infused in ventricle system by special technique in seven adult cadavers, and conducted hands-on neuroendoscopy and skull base surgery workshop, and delegates practiced the ventriculoscopy, third ventriculostomy, CSF leak repair, septostomy, and various skull base approaches. The cadaver is preserved soft life like with flexibility and color which makes it ideal for learning any skull base surgery.

Results: In seven cadavers, the CSF circulation was established. On endoscopy, CSF found circulating in ventricular system exactly lifelike. The texture of brain tissue, choroid plexus, and other parts of brain were preserved lifelike. All delegates (neurosurgeons) expressed that it was real surgery like feel and opined that this method is going to enhance ventriculoscopy skill learning in neurosurgeons.

Conclusion: This technique of making CSF circulation of the ventricular system in cadaver is very unique and innovative, allowing surgical training for ventriculoscopy approaches and skull base surgeries. The realistic anatomy, haptic feedback, and exposure to the same equipment used in live surgery make this cadaveric model ideal for resident training in neuroendoscopy.

Publication History

Article published online:
12 February 2021