Abstract
Objective 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 A 5-point questionnaire was used to assess pre- and posttraining confidence scores.
Results High-pressure extravasation at normal arterial blood pressure mimicked real intraoperative
internal carotid artery (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.
Keywords
internal carotid artery - endoscopic skull base surgery - transsphenoidal - resident
training - simulation
