Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study
Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study
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DOI：
10.3171/2015.8.jns151346
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发表时间：
2016-10-01
影响因子：
4.1
通讯作者：
Preul, Mark C.
中科院分区：
文献类型：
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作者：
Belykh, Evgenii;Lei, Ting;Preul, Mark C.
目的微血管吻合术是神经外科的一项基本技术，应在实验室掌握。人和牛的胎盘已经被提出作为方便的手术实践模型，然而，这些组织的组织学特征还没有与人的脑血管进行比较，并且这些模型还没有被验证为模拟训练模型。在这项研究中，作者评估了使用人和牛胎盘血管的微血管搭桥模拟模型的结构、表面和内容的有效性。方法对30个人和10个牛胎盘的血管节段进行解剖学和组织学评估。受训人员(10名实习神经外科医生和7名有显微外科经验的住院医生)和未受过培训的参与者(10名医学生和3名没有经验的住院医生)按照所描绘的训练模块对胎盘模型进行微血管搭桥手术。使用西北客观显微吻合评估工具(NOMAT)量表和培训后调查对模型的吻合口性能和效果进行评估。结果人胎盘动脉与大脑和颞浅动脉相似，牛胎盘静脉与颈内动脉和放射状动脉相似。未训练组的NOMAT平均成绩为37.2+/-7.0，训练组为62.7+/-6.1(p<；0.01；结构效度)。分配给任何一组的50%概率对应于50个NOMAT点。在培训后的调查中，17名受过培训的参与者中有16名(94%)给模型的真实搭桥手术的重复性打了高分，17名参与者中有16名(94%)给难度打了“相同”分(表面效度)。所有参与者中，30人(100%)对该模型改进显微外科技术的能力(内容效度)做出了肯定的回答。结论人胎盘动脉和牛胎盘静脉是方便的、解剖学上相关的、有益的显微神经外科培训模型。使用这些模型模拟的显微吻合具有较高的表面、内容和结构效度。NOMAT评分超过50分表示成功完成显微吻合术。
OBJECTIVE Microvascular anastomosis is a basic neurosurgical technique that should be mastered in the laboratory. Human and bovine placentas have been proposed as convenient surgical practice models; however, the histologic characteristics of these tissues have not been compared with human cerebral vessels, and the models have not been validated as simulation training models. In this study, the authors assessed the construct, face, and content validities of microvascular bypass simulation models that used human and bovine placental vessels.METHODS The characteristics of vessel segments from 30 human and 10 bovine placentas were assessed anatomically and histologically. Microvascular bypasses were performed on the placenta models according to a delineated training module by "trained" participants (10 practicing neurosurgeons and 7 residents with microsurgical experience) and "untrained" participants (10 medical students and 3 residents without experience). Anastomosis performance and impressions of the model were assessed using the Northwestern Objective Microanastomosis Assessment Tool (NOMAT) scale and a posttraining survey.RESULTS Human placental arteries were found to approximate the M-2-M-4 cerebral and superficial temporal arteries, and bovine placental veins were found to approximate the internal carotid and radial arteries. The mean NOMAT performance score was 37.2 +/- 7.0 in the untrained group versus 62.7 +/- 6.1 in the trained group (p < 0.01; construct validity). A 50% probability of allocation to either group corresponded to 50 NOMAT points. In the posttraining survey, 16 of 17 of the trained participants (94%) scored the model's replication of real bypass surgery as high, and 16 of 17 (94%) scored the difficulty as "the same" (face validity). All participants, 30 of 30 (100%), answered positively to questions regarding the ability of the model to improve microsurgical technique (content validity).CONCLUSIONS Human placental arteries and bovine placental veins are convenient, anatomically relevant, and beneficial models for microneurosurgical training. Microanastomosis simulation using these models has high face, content, and construct validities. A NOMAT score of more than 50 indicated successful performance of the microanastomosis tasks.