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Simulation of a High-Flow Extracranial-Intracranial Bypass Using a Radial Artery Graft in a Novel Fresh Tissue Model

Russin, Jonathan J. MD*; Mack, William J. MD*; Carey, Joseph N. MD; Minneti, Michael BS, RRT; Giannotta, Steven L. MD*

doi: 10.1227/NEU.0b013e318266e7c6
Surgical Anatomy and Technique

BACKGROUND: Microsurgical vascular anastomosis techniques are technically challenging and used in only a narrow spectrum of neurosurgical procedures. Opportunities for instruction and application have become increasingly rare during standard neurosurgery residencies.

OBJECTIVE: To create a neurovascular simulation model that more closely approximates the clinical environment. This article describes a novel surgical model using vascular pressurization in a fresh cadaver to simulate an extracranial-to-intracranial bypass.

METHODS: Fresh cadavers were obtained according to the standard operating procedures of the University of Southern California Fresh Tissue Dissection Laboratory. The femoral vessels were cannulated and the entire cadaver pressurized. A high-flow bypass from the common carotid artery to the middle cerebral artery was performed using a radial artery graft.

RESULTS: This system has several advantages for neurosurgical simulation. The fresh tissue reproduces intraoperative haptics and anatomy. Extracranial-to-intracranial bypass is a physically demanding procedure and can become fatiguing and frustrating for beginners. This model more closely simulates clinical operative time and conditions. The surgeon is able to rehearse the steps and progression of the operation as opposed to simply focusing on the anastomosis. Surgeon positioning and microscope placement are often difficult for novices. By simulating the operating room conditions, these steps can be practiced, providing experience that can be directly translated to the clinical arena.

CONCLUSION: Despite the decrease in frequency, indications for bypass procedures still exist in neurosurgery. The fresh tissue pressurization model offers significant benefits when training neurosurgeons to perform these technically demanding procedures.

ABBREVIATIONS: EC-IC, extracranial-intracranial

FTDL, Fresh Tissue Dissection Laboratory

PVC, polyvinyl chloride

*Department of Neurosurgery and

Department of General Surgery, University of Southern California, Los Angeles, California

Correspondence: Jonathan Russin, MD, Department of Neurosurgery, University of Southern California, 1200 North State Street, Suite 3300, Los Angeles, CA 90033. E-mail:

Received April 03, 2012

Accepted June 20, 2012

Copyright © by the Congress of Neurological Surgeons