Shortening the learning curve in endoscopic endonasal skull base surgery: a reproducible polymer tumor model for the trans-sphenoidal trans-tubercular approach to retro-infundibular tumors

Clin Neurol Neurosurg. 2013 Sep;115(9):1635-41. doi: 10.1016/j.clineuro.2013.02.013. Epub 2013 Mar 5.

Abstract

Background: Endoscopic endonasal skull base surgery attracts an increasing number of young neurosurgeons. This recent technique requires specific technical skills for the approaches to non-pituitary tumors (expanded endoscopic endonasal surgery). Actual residents' busy schedules carry the risk of compromising their laboratory training by limiting significantly the dedicated time for dissections.

Objective: To enhance and shorten the learning curve in expanded endoscopic endonasal skull base surgery, we propose a reproducible model based on the implantation of a polymer via an intracranial route to provide a pathological retro-infundibular expansive lesion accessible to a virgin expanded endoscopic endonasal route, avoiding the ethically-debatable need to hundreds of pituitary cases in live patients before acquiring the desired skills.

Methods: A polymer-based tumor model was implanted in 6 embalmed human heads via a microsurgical right fronto-temporal approach through the carotido-oculomotor cistern to mimic a retro-infundibular tumor. The tumor's position was verified by CT-scan. An endoscopic endonasal trans-sphenoidal trans-tubercular trans-planum approach was then carried out on a virgin route under neuronavigation tracking.

Results: Dissection of the tumor model from displaced surrounding neurovascular structures reproduced live surgery's sensations and challenges. Post-implantation CT-scan allowed the pre-removal assessment of the tumor insertion, its relationships as well as naso-sphenoidal anatomy in preparation of the endoscopic approach.

Conclusion: Training on easily reproducible retro-infundibular approaches in a context of pathological distorted anatomy provides a unique opportunity to avoid the need for repetitive live surgeries to acquire skills for this kind of rare tumors, and may shorten the learning curve for endoscopic endonasal surgery.

Keywords: Endoscopic endonasal surgery; Laboratory training; Neurosurgical education; Retro-infundibular tumor; Skull base; Tumor model.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cadaver
  • Endoscopy / methods*
  • Humans
  • Hypothalamus / anatomy & histology
  • Hypothalamus / surgery
  • Learning Curve*
  • Models, Anatomic
  • Nasal Cavity / anatomy & histology*
  • Nasal Cavity / surgery*
  • Neurosurgery / education*
  • Neurosurgical Procedures / methods*
  • Polymers
  • Skull Base / anatomy & histology*
  • Skull Base / surgery*
  • Skull Base Neoplasms / surgery*
  • Sphenoid Bone / anatomy & histology
  • Sphenoid Bone / surgery
  • Thalamus / surgery*
  • Tomography, X-Ray Computed

Substances

  • Polymers