Human cadaver brain infusion skull model for neurosurgical training

Abstract

Background: Microsurgical technique and anatomical knowledge require extensive laboratory training. Human cadaver models are especially valuable as they supply a good microsurgical training environment simultaneously providing authentic brain anatomy. We developed the "skull infusion model" as an extension of our previous "brain infusion model" taking it a step further maintaining simplicity but enhancing realism.

Methods: Four human cadaveric brains donated for educational purposes were explanted at autopsy. The specimens were prepared cannulating carotid and vertebral arteries with plastic tubings, flushed with abundant water and fixed for 1 month in formaldehyde. They were then enclosed with white silk clothing (emulating the dura mater) and inserted into human skulls cut previously into two pieces. Tap water at a flow rate of 10 L/h was infused through the arterial tubings.

Results: Diverse microsurgical procedures were performed by two trainees, including craniotomies with microsurgical approaches and techniques such as sylvian fissure exposure, extra-intracranial and intra-intracranial bypass, approaches to the ventricles and choroidal fissure opening. The water infusion fills the arterial system, leaking into the interstitial and cisternal space and finally moistening the whole specimen. This makes vascular microsurgical techniques become extremely realistic, increasing its compliance making manipulations easier and more authentic.

Conclusions: Standard microsurgical laboratories frequently have difficulties to work with decapitated human cadaver heads but could have human brains readily available. Using the infusion model and inserting it in a human skull makes the environment much more realistic. Its simplicity and inexpensiveness make it a good alternative for developing microsurgical techniques.

Keywords: Bypass; cadaver; cerebrovascular; infusion model; skull; surgical training.

Figure 1

(a) Brain vessel cannulation and insertion in silk cloth. (b) Frontotemporal craniotomy and exposure. (c) Right sylvian fissure exposure

Figure 2

(a) High flow bypass to right middle cerebral artery. (b) Angiography of specimen in (2a) injecting contrast through carotid artery (note the permeability of the bypass). (c) Angiography of specimen in (2a) injecting contrast through the bypass (note the injection of the right middle cerebral artery territory as well as light staining of the anterior cerebral arteries)