Management of Intraoperative Aneurysmal Rupture: Is there a Way to Practice and Simulate it in the Lab?

Abstract

Introduction: Intraoperative rupture of an intracranial arterial aneurysm represents a feared and sometimes disastrous complication. The incidence rates vary between 6 and 40% of cases, recent studies referred to a rate of 9.2%—the risk of intraoperative rupture is affected by aneurysm location, subarachnoid hemorrhage, temporary arterial occlusion, and certainly to the surgeon's experience and technical skills. Here, we present a cadaveric training model to prepare residents on how to manage intraoperative aneurysmal ruptures. Methods: Artificial aneurysms were modeled and placed in the anterior circulation (MCA, ICA bifurcation, and paraclinoid region, PcomA) on cadaver heads especially prepared according to the “Live Cadaver” (Perfused Cadaver model, ANI, Little Rock, United States). Overall 40 residents were theoretically and practically trained on how to deal with intraoperative aneurysm rupture. Different clipping tenets and technical strategies were demonstrated and practiced. The practical steps consisted in approaching and dissecting the cadaveric aneurysm model, the simulation of the clipping procedure was performed under unruptured and ruptured conditions. Results: The vast majority of the residents performed the clipping procedure adequately and correctly. Even less experienced residents with few or no microvascular skills showed a fast learning curve, felt more self-confident with the handling of instruments and clips, and, according to their feedback, confirmed the importance of practicing microsurgical skills in the laboratories using simulation. Conclusion: The “Live Cadaver” is a unique and realistic training and simulation tool for the management of intraoperative vascular injuries and aneurysmal rupture.