Navigation-guided Endoscopic Intraventricular Injectable Tumor Model: Cadaveric Tumor Resection Model for Neurosurgical Training.

Navigation-guided Endoscopic Intraventricular Injectable Tumor Model: Cadaveric Tumor Resection Model for Neurosurgical Training.

World Neurosurg. 2016 Apr 21;

Authors: Ashour AM, Elbabaa SK, Caputy AJ, Gragnaniello C

Abstract
BACKGROUND: Intraventricular tumors present difficult challenges to the neurosurgeon. Neurosurgeons have begun to explore the possibilities of using the endoscope in the radical resection of solid intraventricular lesions. There is a steep learning curve when dealing with such lesions with an endoscope.
OBJECTIVE: The aim of this study was to create a laboratory training model for pathological intraventricular neuroendoscopic surgery guided by the navigation system. We believe this technique is more reliable than the traditional approach using contrast injection with C-arm x-ray guidance.
MATERIALS AND METHODS: Five formalin-fixated, latex-injected cadaveric heads were used. The arterial system was injected with red latex through the common carotid arteries, and the venous system was injected with blue latex through the internal jugular veins at the C6 vertebral level. The contrast-enhancing tumor polymer, Stratathane resin ST-504 derived polymer (SRSDP), was injected into the lateral ventricle via Frazier's point under direct endoscopic visualization and real-time neuronavigation guidance. When navigation was used for trajectory planning, the peel-away sheath was registered using a frameless navigational system (BrainLAB, Feldkirchen, Germany). A questionnaire was distributed to all the participants of an endoscopic cadaveric course where the models were used to evaluate the endoscopic tumor model.
RESULTS: Neurosurgeon participating at a course performed an endoscopic approach to resect the intraventricular tumor model through an ipsilateral frontal burr hole. The properties of the SRSDP mixture could be manipulated through varying concentrations of the materials used, in order to reach the desired consistency of a nodular solid lesion and possibility for piecemeal resection. The tumor model allowed participants to compare between normal and pathological endoscopic anatomy in the same cadaveric head.
CONCLUSION: This injectable tumor model with the combination of neuroendoscopy and navigation can improve the accuracy of the endoscopic approach and minimize the risk of cadaveric brain specimen damage that in return augments the feeling of lifelike conditions. Using this endoscopic injectable tumor model technique can assist neurosurgeons` preparation for the challenges associated with an endoscopic piecemeal resection of a solid lesion in the lateral or third ventricle.

PMID: 27109629 [PubMed - as supplied by publisher]

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