Development and Validation of a Novel Human Fixed Cadaveric Model Reproducing Cerebrospinal Fluid Circulation for Training in Endoscopic Skull Base Surgery
Notice bibliographique
Résumé
Background: Endoscopic endonasal skull base reconstruction is a complex skill to acquire during surgical training. Currently described cadaveric models for training purposes mainly use fresh-frozen cadaveric heads, which have the disadvantage of being less accessible and less reusable than formaldehyde treated specimens. Another drawback of currently described models is the general lack of measurement of the pressure generated by the simulated cerebrospinal fluid (CSF) flow. Objective: To elaborate and validate the practicality of a human formaldehyde-fixed cadaveric model that reproduces a realistic CSF circulation and that adequately renders a CSF leak similar to those encountered during endoscopic endonasal skull base surgery. Methods: An external ventricular drain that connects with a peristaltic pump is placed under direct visualization in the subarachnoid spaces of the interpeduncular cisterns, which allows a water circulation that reproduces CSF circulation. A fiber-optic intracranial pressure (ICP) sensor is also used, to measure intracranial pressure at all times and adjust water flow to obtain ICP measurements similar to those encountered during surgery. Endoscopic endonasal skull base approaches reflecting the currently most used corridors are performed, to create different skull base openings and CFS leaks. Medical students, surgical residents as well as experienced ENT surgeons and neurosurgeons were tasked with reconstruction of the various defects using a standardized multilayered approach, with the goal of obtaining a watertight closure under normal ICP ranges. Compiled data included total reconstruction time, continuous ICP monitoring and success/failure to achieve watertight reconstruction. A Likert questionnaire was used to evaluate authenticity and usefulness of the model. Results: The newly created human fixed cadaveric model reproduced CSF circulation in all tested conditions. The model was tested multiple times on four different specimens, with four different types of dural defects (sellar, suprasellar, transcribriform and transclival). Intracranial pressures were similar to physiologic conditions (between 12 and 20 mm Hg) and were reproducible with fixed peristaltic pump parameters. Each reconstruction could easily be tested for any residual leaks and success rate concurred with the training level. There was a strong correlation between subjective assessment of the quality of skull base reconstruction and intracranial pressure after reconstruction. Ninety-four percent of participants strongly agreed that the cadaveric model was realistic and allowed them to improve their surgical skills, as well as their endoscopic abilities. Conclusion: This novel human fixed cadaveric model for CSF circulation is efficient and adequately reproduces surgical conditions, as well as CSF leaks created by different skull base approaches. The newly created cadaveric model is accessible, easy to reproduce and can be reused. It can be used as a tool for research purposes and as a learning tool for endoscopic endonasal skull base surgery, which usually require a long learning curve for residents and trainees. Publication History Article published online: 01 February 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».