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. 2014 Oct;75(5):301-8.
doi: 10.1055/s-0034-1368148. Epub 2014 Jul 21.

Intracranial injectable tumor model: technical advancements

Cristian Gragnaniello  1 , Filippo Gagliardi  2 , Anthony M T Chau  1 , Remi Nader  3 , Alan Siu  4 , Zachary Litvack  4 , Bruno De Luca  5 , Kevin Seex  1 , Pietro Mortini  2 , Anthony J Caputy  4 , Ossama Al-Mefty  6
Affiliations

Intracranial injectable tumor model: technical advancements

Cristian Gragnaniello et al. J Neurol Surg B Skull Base. 2014 Oct.

Abstract

Background and Objectives Few simulation models are available that provide neurosurgical trainees with the challenge of distorted skull base anatomy despite increasing importance in the acquisition of safe microsurgical and endoscopic techniques. We have previously reported a unique training model for skull base neurosurgery where a polymer is injected into a cadaveric head where it solidifies to mimic a skull base tumor for resection. This model, however, required injection of the polymer under direct surgical vision via a complicated alternative approach to that being studied, prohibiting its uptake in many neurosurgical laboratories. Conclusion We report our updated skull base tumor model that is contrast-enhanced and may be easily and reliably injected under fluoroscopic guidance. We have identified a map of burr holes and injection corridors available to place tumor at various intracranial sites. Additionally, the updated tumor model allows for the creation of mass effect, and we detail the variation of polymer preparation to mimic different tumor properties. These advancements will increase the practicality of the tumor model and ideally influence neurosurgical standards of training.

Keywords: microsurgery; neurosurgical training; skull base; tumor model.

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Figures

Fig. 1
Fig. 1
Map of burr holes.
Fig. 2
Fig. 2
Injection technique. (A) Transoral insertion of a Foley catheter into the posterior cranial fossa. (B) Floated catheter tip in the clival region. (C) Clival region after polymer injection.
Fig. 3
Fig. 3
Image processing. Appearance of X-rays after polymer injection. (A) Left anterior falx meningioma. (B) Left sphenoid wing meningioma. (C) Olfactory groove meningioma.
Fig. 4
Fig. 4
Intraparenchymal lesion. (A) Polymer injected in the left parietal cortex. (B) Tumor dissection. (C) Postoperative computed tomography showing incomplete tumor resection.
Fig. 5
Fig. 5
Image processing. Computed tomography appearance after polymer injection. (A–C) Axial, sagittal, and coronal contrast-enhanced images of a large tentorial lesion. (D) Three-dimensional reconstruction algorithm (red dots highlight lesion margins).
Fig. 6
Fig. 6
Microscopic view. (A, B) Tumor dissection through the optic-carotid window. (C) Tumor extension into the optic canal after opening the optic sheet.
See this image and copyright information in PMC

References

    1. Gragnaniello C, Nader R, van Doormaal T. et al.Skull base tumor model. J Neurosurg. 2010;113(5):1106–1111. - PubMed
    1. Sanan A Abdel Aziz K M Janjua R M van Loveren H R Keller J T Colored silicone injection for use in neurosurgical dissections: anatomic technical note Neurosurgery 19994551267–1271., discussion 1271–1274 - PubMed
    1. Zhao J C Chen C Rosenblatt S S et al.Imaging the cerebrovascular tree in the cadaveric head for planning surgical strategy Neurosurgery 20025151222–1227.; discussion 1227–1228 - PubMed
    1. Cunha e Sá M. Additional competence training charter in neurosurgical oncology. Acta Neurochir (Wien) 2010;152(6):1095–1098. - PubMed
    1. Abe M Tabuchi K Goto M Uchino A Model-based surgical planning and simulation of cranial base surgery Neurol Med Chir (Tokyo) 19983811746–750.; discussion 750–751 - PubMed

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