Human Placenta Simulator for Intracranial–Intracranial Bypass: Vascular Anatomy and 5 Bypass Techniques

• Published in: World neurosurgery Vol. 119; pp. e694 - e702
• Main Authors: Oliveira, Marcelo Magaldi, Wendling, Leonardo, Malheiros, Jose Augusto, Nicolato, Arthur, Prosdocimi, Andre, Guerra, Luiza, Costa, Pollyana H.V., Ferrarez, Carlos Eduardo, Ferreira, Mauro Tostes, Sauvageau, Eric, Hanel, Ricardo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2018
• Subjects: Anastomosis, Surgical - education; Cerebral Revascularization - education; Cerebrovascular surgery; Clinical Competence - standards; Concurrent validity; Construct validity; Female; Human placenta; Humans; Intracranial–intracranial bypass; Microsurgery; Microsurgery - education; Microsurgery - standards; Models, Anatomic; Neurosurgeons - education; Neurosurgeons - standards; Neurosurgical Procedures - education; Neurosurgical Procedures - standards; Neurosurgical simulation; Placenta - blood supply; Pregnancy; Reproducibility of Results; Simulation Training - methods; Construct validity; Human placenta; Neurosurgical simulation; Cerebrovascular surgery; Intracranial–intracranial bypass; Concurrent validity; Microsurgery; MCA; IQR; VA; IC-IC; ACA
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.07.246

Intracranial-intracranial (IC-IC) bypass surgery involves the use of significant technical bimanual skills. Indications for this procedure are limited, so training in a simulator with brain vessels similarity could maintain microsurgical dexterity. Our goal is to describe the human placenta vascular anatomy to guide IC-IC bypasses apprenticeship. Human placenta vascular anatomy was reported and validated with comparison to brain main vessels after studying the vascular tree of 100 placentas. Five simulated IC-IC bypasses (end to end, end to lateral, lateral to lateral, aneurysm bridge, and aneurysm exiting branch transposition) were developed and construct and concurrent validated. Statistical analysis using the t variance test was performed with a confidence interval of 0.95. A total of 1200 placenta vessels were used for test–retest validation with a reliability index of 0.95. All 100 human placentas were suitable to perform the 5 different bypasses. Construct validity showed a P < 0.005. Concurrent validity highlighted the technical differences among simulators. An ex vivo bypass model offers great similarity to main brain vessels with the possibility to practice a variety of IC-IC bypass techniques in a single simulator. Placenta vascular anatomy knowledge can improve laboratory microsurgical training. •We describe and validate human placenta vascular anatomy and 5 different IC-IC bypasses done in a single simulation.•A total of 1200 placenta vessels were used for test–retest validation with a reliability index of 0.95.•All 10 human placentas were suitable to perform the 5 different bypasses. Construct validity was P < 0.005.•Human placenta bypass model is unique regarding its vessel similarity to main brain vessels.•Human placenta offers a variety of IC-IC bypass techniques in a single simulator.