The Hibiscus model: A feasible cadaveric model using continuous arterial circulation for intracranial bypass training and its validation

OBJECTIVE

The frequency of intracranial bypass procedures has declined. Thus, it is difficult for neurosurgeons to develop the necessary skills for this complex procedure. We present a perfusion-based cadaveric model to provide a realistic training experience with high anatomical and physiological fidelity as well as instantaneous assessment of bypass patency. Validation was assessed by evaluating the educational impact and skill improvement of the participants.

METHODS

Fourteen participants attended a hands-on revascularization course with seven cadaveric models connected to a continuous arterial circulation system pumping a red-colored solution through the entire cranial vasculature, mimicking blood circulation. The ability to perform a vascular anastomosis was evaluated initially. Further, a questionnaire on prior experience was provided. At the end of the 36-hour course, the ability to perform an intracranial bypass was re-examined and the participants completed a self-assessment questionnaire.

RESULTS

Initially, only three attendees were able to perform an end-to-end anastomosis within the time limit, and only two of these anastomoses showed adequate patency. After having accomplished the course, all participants were able to complete a patent end-to-end anastomosis within the time limit, thus, demonstrating a significant improvement. Further, both overall educational gain and surgical skills were regarded as remarkable (n=11 and n=9) CONCLUSIONS: Simulation-based education is considered an important aspect of medical and surgical development. The presented model is a feasible and accessible alternative to the prior models used for cerebral bypass training. This training may serve as a helpful and widely available tool to improve neurosurgeons´ development irrespective of financial resources.