A novel training model for superficial temporal artery (STA)- middle cerebral artery (MCA) anastomosis using microsurgical techniques

Abstract

To create a reusable and inexpensive training model with technological tools that simulates cerebral bypass surgery and a sensor system that provides tactile feedback to the surgeon. Furthermore, we aimed to evaluate the anastomotic stability and contribution to the surgeon's learning curve. We created a superficial temporal artery (STA)-middle cerebral artery (MCA) bypass simulation model using chicken and turkey brachial arteries. A cranium model was printed with a three-dimensional printer for craniotomy and cerebral parenchyma was created by pouring silicone into the cranial mold. A blood flow simulation system was also prepared. Pressure-sensitive sensors were placed on parenchyma, and tactile conditioning was performed via audible warning from the sensors. 24 anastomosis were performed with different sutures and hand tools. Anastomosis completion times and durability and the number of touches and pressures applied to the parenchyma were recorded. The stability of the anastomoses was evaluated by increasing the pressure in the blood flow simulation system, so usefulness of the training model was evaluated. The time required for anastomosis completion decreased as the number of practices (p < 0.05). As the number of practices increased, the number of parenchymal touches decreased (p < 0.05). With practice, the time required for anastomosis completion and number of parenchymal touches decreased. Thus, the model is useful, inexpensive, reusable, easily accessible and contributes to the surgeon's learning curve. Our model with pressure-sensitive sensors can be used for microsurgery practice, enabling the surgeons to gain tactile conditioning and evaluate anastomotic stability and leakage.