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J Craniofac Surg. 2018 Jan;29(1):e25-e28. doi: 10.1097/SCS.0000000000004042.

Skull Base Neuroendoscopic Training Model Using a Fibrous Injectable Tumor Polymer and the Nico Myriad.

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Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
Department of Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
Department of Neurosurgery, George Washington University, Washington DC.


The Myriad is an innovative, high precision tool for tumor resection, designed to work within narrow endoscopic corridors. Due to its application in technically demanding situations, the learning curve associated with its use might be extremely challenging and time-consuming.The authors describe the application of an already validated training model, the skull base injectable tumor model (ITM), to allow trainees to practice with the use of the Myriad during endoscopic skull base procedures.A formalin embalmed cadaveric head was used for technical assessment. Stratathane resin ST-504 derived polymer was injected to mimic skull base tumors and Myriad was used for tumor resection during different endoscopic procedures.An endoscopic endonasal transsphenoidal, a trans-planum trans-tuberculum, and a trans-clival approach have been performed after ITM injection. The Myriad was used for tumor debulking and blunt manipulation, qualitatively evaluating the technical challenges in performing the surgical dissection.Injectable tumor model demonstrates to be a valuable educational tool to train surgeons in the use of Myriad, potentially speeding up the learning curve in the acquirement of necessary technical skills in manipulating the instrument, even in case of demanding surgical situation.

[Indexed for MEDLINE]

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