Cadaver Lab Research Articles

Incisional hernia: open abdominal wall reconstruction. Current state of the technique and results

The treatment of complex midline hernias remains aparticular challenge. The currently refined knowledge of the anatomy in the cadaver laboratory and advancing clinical experience have changed our present approach. The aim of this review is to present adescription of the updated surgical procedures and outcomes. We favor the retromuscular or preperitoneal layer for mesh implantation, including the Rives-Stoppa procedure (sublay mesh) and posterior component separation with the Madrid modification. We operated on 334 complex midline incisional hernias: 6.3% retromuscular preperitoneal, 15% after Rives-Stoppa, 2.4% anterior component separation and 76% posterior component separation. Abridging procedure was used in 31%. Acomplication occurred in 35.3%, most of which were wound healing disorders (SSO). The average length of hospital stay was 7.2days. We recorded avery low incidence of long-term complications: 3.3% recurrence, 0.9% chronic pain (daily use of pain medication), 6% bulging, 1.8% chronic seroma and 2.6% chronic mesh infection. Despite the associated morbidity, retromuscular/preperitoneal treatment offers excellent long-term results.

Improving alignment in total knee arthroplasty: a cadaveric assessment of a surgical navigation tool with computed tomography imaging

Purpose To investigate the accuracy of an imageless, optical surgical navigation tool to assist with femoral and tibial bone cuts performed during TKA. Patients and methods Six board-certified orthopedic surgeons participated in a laboratory cadaver investigation, performing femoral and tibial bone cuts with the assistance of a computer navigation tool. Femoral and tibial varus/valgus, tibial slope, femoral flexion, and both femoral and tibial rotation measurements from the device were compared with angular measurements calculated from computed tomography (CT) images of the knees. Results Measurements with the navigation tool were highly correlated with those obtained from CT scans in all three axes. For the distal femoral cut, the absolute mean difference in varus/valgus was 0.83° (SD 0.46°, r = 0.76), femoral flexion was 1.91° (SD 1.16°, r = 0.85), and femoral rotation was 1.29° (SD 1.01°, r = 0.88) relative to Whiteside’s line and 0.97° (SD 0.56°, r = 0.81) relative to the posterior condylar axis. For the tibia, the absolute mean difference in varus/valgus was 1.08° (SD 0.64°, r = 0.85), posterior slope was 2.78° (SD 1.40°, r = 0.60), and rotation relative to the anteroposterior axis (posterior cruciate ligament to the medial third of the tibial tuberosity) was 2.98° (SD 2.54°, r = 0.79). Conclusion Utilization of an imageless navigation tool may aid surgeons in accurately performing and monitoring femoral and tibial bone cuts, and implant rotation in TKA and thus, more accurately align TKA components.

Educational Status of Minimally Invasive Spine Surgery

Abstract Introduction The objective of this study was to understand how spine surgeons learn minimally invasive spine surgery (MISS) and how the COVID-19 pandemic impacted the educational experience of MISS. Potential solutions for increasing the spine surgeon's access to MISS educational resources were also discussed. Methods An internet survey was distributed to neurosurgical and orthopedic spine surgeons across multiple online platforms from April to June 2021, asking specific questions about education and training for MISS. Online survey tools were used to contact spine surgeons in the five geographical continents. Results A total of 303 spine surgeons responded to the survey: 272 (89.7%) neurosurgeons and 31 (10.3%) orthopedic surgeons. The six countries with the greatest number of participants were: Argentina (n = 70; 23.1%), India (n = 47; 15.5%), Brazil (n = 34; 11.2%), Pakistan (n = 10; 3.3%), Mexico (n = 9; 3.0%), and Chile (n = 8; 2.6%). Conclusion Most spine surgeons were able to attend virtual learning events during the pandemic, but cadaveric study was still considered the gold standard for learning MISS. Multidisciplinary effort is needed to develop structured curriculums for teaching MISS that include a variety of educational tools such as cadaver laboratory, guidance from experienced surgeons, and virtual demonstrations.

Biomechanical Comparison of Open vs Percutaneous Techniques for Primary Mid-Substance Achilles Tendon Repair: A Systematic Review and Meta-Analysis

Category: Hindfoot; Basic Sciences/Biologics Introduction/Purpose: Primary repair of mid-substance Achilles tendon rupture may be performed using an open or a percutaneous technique. Previous meta-analyses of clinical data comparing the two techniques have demonstrated mostly equivalent functional outcomes and re-rupture rates. Individual cadaveric studies have also compared the biomechanical properties of the two approaches. However, the results of these studies have been heterogeneous, and there is currently no consensus as to whether one technique may be biomechanically superior. The purpose of this meta-analysis was to evaluate the biomechanical properties of open versus percutaneous Achilles tendon repair. Methods: A systematic review of original research articles was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. To qualify for study inclusion, articles were required to be published in English, utilized a cadaveric laboratory design, and had to directly compare the biomechanical properties of open Achilles repair using a Krackow or Kessler technique versus percutaneous repair using either the PARS (Arthrex) or Achillon (Integra) tendon repair systems. Evaluated outcomes included displacement (mm), load to failure (N), and stiffness (N/m). Results: Nine studies met inclusion criteria, including 190 cadaveric specimens (open: 83, PARS: 56; Achillon: 51) that underwent primary mid-substance Achilles tendon repair. Pooled analysis demonstrated no statistically significant difference in displacement (p = 0.418; Figure 1), load to failure (p = 0.923; Figure 2), or stiffness (p = 0.195; Figure 3) between the open and percutaneous techniques. Among the percutaneous approaches, there was no difference in displacement (p = 0.109; Figure 4) between the PARS and Achillon tendon repair systems. Conclusion: The results of this study suggest that both open and percutaneous techniques are biomechanically viable approaches for primary mid-substance Achilles tendon repair. These biomechanical findings must be interpreted in the context of clinical outcomes data as well as the differing complication profiles of the two techniques to best inform the surgical decision-making process for primary mid-substance Achilles tendon repair.

A Crucial Study on Dead Body Preservation

Abstract: A medical student who never stepped in the cadaveric laboratory on his institute during the first year can neither be a good physician or surgeon in his medical career .so dissection plays a very important role in learning anatomy completely. Anatomy is the branch of medicine where study of structures of human body is done at the level of first year of academic course of every medical profession. For learning anatomy there must be a dead body for better knowledge and study. Dissection is a long-lasting procedure which is carried out in every medical teaching institute This process of preservation of human dead body is called embalming

Indicators of surgical stress and influence of clinical experience, simulation models, and cadaveric laboratory on the stress response of third-year veterinary students performing first elective surgery.

To evaluate the role of simulation models and previous surgical experience on subjective and objective stress levels of students performing their 1st elective surgery within the veterinary curriculum. 141 third-year veterinary students. Using a pre-post experimental design, salivary alpha-amylase, and cortisol were evaluated as markers of physiologic stress response before students' first elective surgery. Student self-reported State-Trait Anxiety Inventory (STAI) scores and quantitative measures of experience were correlated to biomarker results. No association was found for change in salivary biomarkers of stress, alpha-amylase, and cortisol, between baseline and presurgical samples accounting for gender, age, type of elective surgery performed, previous surgical experience, or simulation model use. Salivary cortisol levels were markedly elevated falling between the 66th and 99th percentile compared to an age and gender-matched population. Salivary alpha-amylase levels were also 2 to 3 times higher than those recorded by other health professionals. Veterinary student STAI scores were high falling between the 65th and 73rd percentile compared to working adults in the general population. Veterinary students' salivary cortisol, alpha-amylase, and STAI scores fell into the upper 2/3rds of the general population, demonstrating a high level of stress. Simulation models and previous surgical experience were not associated with decreased stress. Further evaluation of the implementation of high-fidelity simulation models and the role of stress on performance is indicated.

Development of associational fiber tracts in fetal human brain: a cadaveric laboratory investigation.

The advent of diffusion tensor imaging (DTI) in addition to cadaveric brain dissection allowed a comprehensive description of an adult human brain. Nonetheless, the knowledge of the development of the internal architecture of the brain is mostly incomplete. Our study aimed to provide a description of the anatomical variations of the major associational bundles, among fetal and early post-natal periods. Seventeen formalin-fixed fetal human brains were enrolled for sulci analysis, and 13 specimens were dissected under the operating microscope, using Klingler's technique. Although fronto-temporal connections could be observed in all stages of development, a distinction between the uncinate fascicle, and the inferior fronto-occipital fascicle was clear starting from the early preterm period (25-35 post-conceptional week). Similarly, we were consistently able to isolate the periatrial white matter that forms the sagittal stratum (SS), with no clear distinction among SS layers. Arcuate fascicle and superior longitudinal fascicle were isolated only at the late stage of development without a reliable description of their entire course. The results of our study demonstrated that, although white matter is mostly unmyelinated among fetal human brains, cadaveric dissection can be performed with consistent results. Furthermore, the stepwise development of the associational fiber tracts strengthens the hypothesis that anatomy and function run in parallel, and higher is the cognitive functions subserved by an anatomical structure, later the development of the fascicle. Further histological-anatomical-DWI investigations are required to appraise and explore this topic.

3-Dimensionally Printed Affordable Nose Model: A Reliable Start in Endoscopic Training for Young Neurosurgeons

Training neurosurgical skills is one of the most important tasks of a residency program. Techniques' complexity and pathology rarity define a long learning curve for mastering different surgical skills for which simulation on anatomic samples is extremely important. For this purpose, cadaver laboratory training is the most reliable tool. However, since access to cadaveric specimens is limited, due to costs and availability, surgical skills could be developed using inanimate models. This work aimed to develop a printable3-dimensional model of the nasal cavity and sellar floor using an open-source downloadable file, to give residents the opportunity to improve their endoscopic surgical skills in a low-risk atmosphere with little cost. The 3D model was realized taking as a sample a real-case CT scan imaging from which the sellar floor was removed. A quail egg was placed underneath the printed model covering the sellar floor opening. Under endoscopic visualization, the "sellar floor" was drilled by each participant with the goal of sparing the egg's inner membrane. Once the task was achieved, surgeons were asked to participate in a satisfaction survey. The total cost for printing was 6.31€ (6,72$). A satisfaction survey showed technical improvement (90%), increased confidence (80%), and bringing learned skills into the operating room (70%), leading to a 100% agreement in introducing this project into residency programs. Training on affordable anatomic models represents a useful tool in technical skills improvement. We believe this model could help residents bring their technical capabilities to more sophisticated levels.

Comparing Skill Acquisition and Validity of Immersive Virtual Reality with Cadaver Laboratory Sessions in Training for Reverse Total Shoulder Arthroplasty.

In a randomized controlled trial, junior orthopaedic surgery residents were assigned to a 1-hour training with either iVR or a cadaveric laboratory session with shoulder specimens. Before training, all participants viewed an overview lecture and technique video demonstrating key steps of augmented baseplate implantation for rTSA. Participants were assessed by a blinded evaluator using validated competency checklists during cadaveric glenoid baseplate implantation. Continuous and categorial variables were analyzed using the 2-sample t test and Fisher exact test. Fourteen junior residents (3 incoming matched postgraduate year [PGY1], 6 PGY1s, 1 PGY2, and 4 PGY3s) were randomized to training with either iVR (n = 6) or cadaver laboratory (n = 8). There were no significant differences in demographic data, previous experience with rTSA, or previous use of iVR (p > 0.05). There were no significant difference in total Objective Structured Assessment of Technical Skill score (91.2% [15.2] vs. 93.25% [6.32], -0.1406 to 0.1823, p = 0.763), Global Rating Scale score (4.708 [0.459] vs. 4.609 [0.465], -0.647 to 0.450, p = 0.699), or time to completion (546 seconds [158] vs. 591 seconds [192], -176.3 to 266.8, p = 0.655) in cadaveric glenoid baseplate implantation. Average cost of iVR hardware and a 1-year software license was $4,900, and average cost of a single cadaver laboratory was $1,268.20 per resident. Among junior orthopaedic residents, there is similar skill acquisition when training with either cadaver laboratory or iVR. Although additional research into this field is needed, iVR may provide an important and cost-effective tool in surgical education. Emerging simulation and iVR technology simulation in surgical training programs can increase access to effective and high-level surgical training across the globe and improve quality of care.

The Royal College of Surgeons of England Damage Control Orthopaedic Trauma Skills course (DCOTS): resuscitative knowledge and confidence in surgical skills are reliably maintained at six months post course.

Since 2012, the Damage Control Orthopaedic Trauma Skills course (DCOTS) has trained more than 250 surgeons in the principles and practice of damage control orthopaedics and early appropriate care. This Royal College of Surgeons of England (RCS England) course takes place at the RCS England Partner cadaver laboratory at Brighton and Sussex Medical School. Trauma is a leading cause of morbidity and mortality in the UK, and the course has tried to pass on the lessons of war and conflict from its military faculty and hard-won lessons of "developed world" trauma from its experienced civilian faculty. Participating surgeons were invited to score their self-reported confidence before attending the DCOTS course, immediately afterwards and again 6 months later. A modified four-point Likert scale was used, with responses from 1 = No Confidence to 4 = Very Confident. Damage control resuscitation principles with damage control surgery showed the greatest retained increase at 6 months - 100% - which is extremely satisfying. Self-reported confidence in pelvic external fixation was initially 93% dropping to 85%, which is also considered good to excellent. For pelvic packing, confidence was 90% at the end of the course, up from 19% precourse. This dropped to 62%, which was still considered good but low for the high standards of the course. This may relate to UK trainees' lack of familiarity with the concept. Three of the main skills taught on the DCOTS are effectively retained at 6 months post course.

Poster 354: Biomechanical Comparison of Open versus Percutaneous Techniques for Primary Mid- Substance Achilles Tendon Repair: A Systematic Review and Meta-Analysis

Objectives: Primary repair of mid-substance Achilles tendon rupture may be performed using an open or a percutaneous technique. Previous meta-analyses of clinical data comparing the two techniques have demonstrated mostly equivalent functional outcomes and re-rupture rates. Individual cadaveric studies have also compared the biomechanical properties of the two approaches. However, the results of these studies have been heterogeneous, and there is currently no consensus as to whether one technique may be biomechanically superior. The purpose of this meta-analysis was to evaluate the biomechanical properties of open versus percutaneous Achilles tendon repair. Methods: A systematic review of original research articles was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. To qualify for study inclusion, articles were required to be published in English, utilized a cadaveric laboratory design, and had to directly compare the biomechanical properties of open Achilles repair using a Krackow or Kessler technique versus percutaneous repair using either the PARS (Arthrex) or Achillon (Integra) tendon repair systems. Evaluated outcomes included displacement (mm), load to failure (N), and stiffness (N/m). Results: Nine studies met inclusion criteria, including 190 cadaveric specimens (open: 83, PARS: 56; Achillon: 51) that underwent primary mid-substance Achilles tendon repair. Pooled analysis demonstrated no statistically significant difference in displacement (p = 0.418; Figure 1), load to failure (p = 0.923; Figure 2), or stiffness (p = 0.195; Figure 3) between the open and percutaneous techniques. Conclusions: The results of this study suggest that both open and percutaneous techniques are biomechanically viable approaches for primary mid-substance Achilles tendon repair. These biomechanical findings must be interpreted in the context of clinical outcomes data as well as the differing complication profiles of the two techniques to best inform the surgical decision-making process for primary mid-substance Achilles tendon repair.

(100) Extended Reality-Assisted Surgery (XRAS): A Novel Surgical Training Tool During Cadaver Lab

Abstract Introduction XRAS (extended reality-assisted surgery) is a revolutionary modality that assists the surgeon in real-time by overlaying 3-dimensional computer-generated images into the users’ field of view. Objective To insert a Titan 3-piece inflatable penile implant (IPP) on cadaver A and a male virtue sling on cadaver B while utilizing XRAS as a training tool. Methods Two cadavers were used for this lab. While 2 surgeons were present and operating on the physical bodies, 2 additional physicians were remote and communicating via HoloLens 2 Developer Editions. By utilizing the Apoqlar©Hamburg, Germany application, the 2 remote surgeons could communicate, observe, and advise the live surgery. Cadaver A was in the supine position for a penoscrotal approach while B was in the lithotomy position for placement of the male virtue sling. A questionnaire was issued to attendees after the procedures to evaluate the role of the HoloLens in the operating room. Results While performing the respective surgeries on the two cadavers, XRAS was successfully implemented in real-time. Superimposed virtual surgical devices were placed and manipulated in 3D space during surgery to allow for augmented surgical technique during penile implant and male virtue sling insertion. The questionnaire yielded findings that, of the 4 attendees who participated in the surgery, all were in favor of integrating XRAS into the operating room. Attendees reported minimal overheating and discomfort, and sufficient battery life for a 90-minute interval. Conclusions XRAS represents the next paradigm shift in surgery and surgical training. It provides an augmented surgical view all while ergonomically positioned on the head of the surgeon. Implementation of XRAS in surgery can improve efficiency, education, accuracy, and surgical outcomes. Further studies and evolution of the software are needed to elucidate the value of such technology for real-time surgery. Disclosure Yes, this is sponsored by industry/sponsor: Coloplast Clarification Industry funding only - investigator initiated and executed study Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast

Assessing the impact of neurosurgery and neuroanatomy simulation using 3D non-cadaveric models amongst selected African medical students.

Laboratory dissections are essential to acquire practical skills to perform neurosurgical procedures. Despite being traditionally done on cadavers, they are often unavailable and suffer from cultural barriers in the African context. Non-cadaveric UpSurgeOn neurosurgery models have been developed to bridge this barrier, providing an almost similar experience with the human body. This study aimed to assess the impact of the UpSurgeOn hands-on-touch non-cadaver model training amongst selected Cameroon medical students. An anonymous 35-item questionnaire was distributed online using Google drive systems to medical students who attended UpSurgeOn's hands-on-touch non-cadaver model training course. These questions aimed to capture data on previous experience with neuroanatomy and neurosurgery practicals and the perception, attitudes, and impact of the UpSurgeOn neurosurgery tool. Eighty-six students completed the survey. The mean age was 21.2 ± 1.868 years, 61.6% were males with 62.8% of respondents being medical students in preclinical years. Before the training, 29.4% had a fair knowledge of neuroanatomy. Textbooks and Youtube videos were the main sources of neuroanatomy and neurosurgery knowledge for more than half of the respondents. Up to 91.5% had no prior exposure to a neuroanatomy/neurosurgery cadaver laboratory dissection, and 22.6% and 17.6% had witnessed and performed at least one craniotomy before, respectively. There were 11.1%, 15.5%, and 31.3% of our respondents who had used a surgical microscope, a neurosurgical instrument, and the UpSurgeOn Neurosurgery tool before, respectively. The majority perceived the UpSurgeOn tool easy to use and felt they needed to learn just a few things before getting going with the box. Most thought of increasing the use of the UpSurgeOn Box and saw the need to be part of the training curriculum. Finally, the majority felt this tool helped to increase familiarity and acquire neurosurgical skills, and to develop the orientation skills needed during neurosurgical approaches. Undergraduate exposure to traditional neurosurgery/neuroanatomy labs is limited in Cameroon. Neurosurgery/neuroanatomy practical skills are gained essentially using non-practical means. Most students found the UpSurgeOn tool user-friendly, saw the need to incorporate it as part of their training, and perceived it to be essential in getting acquainted with neurosurgical skills.

First worldwide report on Hugo RAS™ surgical platform in right and left colectomy.

The diffusion of robotic surgery is rapidly and constantly growing in different surgical specialties. Recently, novel robotic platforms have entered into the market. To date, however, most of the reports on their clinical use have specifically focused on gynecological and urological surgery. In this study, we present the first three robotic-assisted colectomies performed with the new Hugo RAS system (Medtronic, Minneapolis, MN, USA). The surgical team had previous robotic experience and completed simulation training and an official 2-day cadaver laboratory session. Operating room setting and trocar layout were planned and two full cadaver procedures were carried out (right and left colectomy). Onsite dry-run sessions were performed before tackling clinical cases. Three patients underwent robotic-assisted colectomies: one left colectomy, two right colectomies with complete mesocolic excision (CME) and high vascular ligation (HVL) at our Institution. Preoperative diagnosis was colonic adenocarcinoma in all cases. A description of the operative room setup, robotic arm configuration and docking angles is provided. Mean docking time and console time were 8 and 259min, respectively. All the surgical steps were completed without critical surgical errors or high-priority alarms. Neither intraoperative complications nor conversions to open surgery were recorded. Postoperative courses were uneventful with a mean length of stay of 5days. Further clinical data and experience are required for procedural standardization and potential integration of the system into robotic general surgery and colorectal programs.

Petroclival Clinoidal Folds and Relationships with Arachnoidal Membranes and Neural Structures of Anterior and Middle Incisural Spaces: Old Neuroanatomical Terms for a New Neurosurgical Speech in Cadaver Labs with Limited Resources Era. Part I: Osteology and Structural Anatomy of Dura Mater.

Purpose The role of cadaver labs in preparing new generations of effective neurosurgeons is of paramount importance. The Authors describe a personal cadaver lab experience aimed at improving the knowledge of a difficult region of the central skull base. The anterior and middle incisural spaces are regions of remarkable anatomical, and surgical interest due to complex relationships between bony, dural, arachnoidal, and neurovascular structures. The primary purpose of this study is (1) to describe the anatomy of this region with particular emphasis on the relationships between the anterior margin of the free edge of the tentorium and the sphenoid and petrous bone; (2) to identify surgical implications in many different types of neurosurgical procedures dealing with this challenging complex anatomic area.Methods Eight fresh, non-formalin-fixed non-silicon-injected adult cadaver heads and five injected formalin-fixed adult cadaver heads were analyzed in this study.Results The anatomical study was focused on the description of the relationships between bony, dural, arachnoid, and neurovascular structures. Surgical implications are described accordingly.Conclusions Detailed anatomical knowledge of this region finds concrete applications in neurosurgical practice since the anterior and middle incisural spaces are often surgically exposed in neoplastic and vascular diseases.

Petroclival Clinoidal Folds and Relationships with Arachnoidal Membranes of Medial Incisural Space: Old Neuroanatomical Terms for a New Neurosurgical Speech in Cadaver Labs with Limited Resources Era. Part III: Arachnoid Membranes, Cranial Nerves, and Surgical Implications.

BACKGROUND Anatomical dissections play an irreplaceable role in the training of new generations of effective neurosurgeons, especially when addressing skull base lesions is required.The Authors describe an inter-laboratory dissection study aimed at improving the knowledge of a complex region of the skull base. The anterior and middle incisural spaces are of remarkable anatomical and surgical interest due to complex relationships between bony, dural, arachnoidal, and neurovascular structures. The primary purposes of this study are to describe the anatomy of this region with particular emphasis on the relationships between the anterior margin of the free edge of the tentorium and the sphenoid and petrous bone; to identify surgical implications in many different types of neurosurgical procedures dealing with this challenging complex anatomic area.METHODS Thirteen anatomical specimens, including five injected specimens, were dissected in this study. In the formalin-fixed specimens, vessels were injected with colored silicone.RESULTS The anatomical study focused on the description of the relationships between bony dural, arachnoid, and neurovascular structures. Surgical implications are described accordingly.CONCLUSIONS Detailed anatomical knowledge of this region finds concrete applications in neurosurgical practice since the anterior and middle incisural spaces are often surgically exposed in neoplastic and vascular diseases. The high-definition pictures reported in this study could represent useful support to understand the anatomy of this complex region.Finally, our study could provide guidance to neurosurgical centers in which resources are limited that are either planning to establish their own cadaver dissection laboratory or failed to do so because of the supposed high-costs.

Petroclival Clinoidal Folds and Relationships with Arachnoidal Membranes of Anterior and Middle Incisural Spaces: Old Neuroanatomical Terms for a New Neurosurgical Speech in Cadaver Labs with Limited Resources Era. Part II: Free Edge of the Tentorium, Petroclinoid Folds, and Incisural Spaces.

BACKGROUND Anatomical dissections play an irreplaceable role in the training of new generations of effective neurosurgeons, especially when addressing skull base lesions is required.The Authors describe an inter-laboratory dissection study aimed at improving the knowledge of a complex region of the skull base. The anterior and middle incisural spaces are of remarkable anatomical and surgical interest due to complex relationships between bony, dural, arachnoidal, and neurovascular structures. The primary purposes of this study are to describe the anatomy of this region with particular emphasis on the relationships between the anterior margin of the free edge of the tentorium and the sphenoid and petrous bone; to identify surgical implications in many different types of neurosurgical procedures dealing with this challenging, complex anatomic area.METHODS Thirteen anatomical specimens, including five injected specimens, were dissected in this study. In the formalin-fixed specimens, vessels were injected with colored silicone.RESULTS The anatomical study was focused on the description of the relationships between bony dural, arachnoid, and neurovascular structures. Surgical implications are described accordingly.CONCLUSIONS Detailed anatomical knowledge of this region finds concrete applications in neurosurgical practice since the anterior and middle incisural spaces are often surgically exposed in neoplastic and vascular diseases. The high-definition pictures reported in this study could represent useful support to understand the anatomy of this complex region.Finally, our study could provide guidance to neurosurgical centers in which resources are limited that are either planning to establish their own cadaver dissection laboratory or failed to do so because of the supposed high-costs.

Arthroscopy and orthopedic residency: a cross-sectional study of training structure in a resource-constrained environment.

orthopedic residency training was established in the West African sub-region a few decades ago, but sub-specialty in arthroscopy has only become established in the last decade. This study was aimed at evaluating available arthroscopy training resources and their impact on skill acquisition by orthopedic residents. this was a cross-sectional study involving the use of a structured online survey of consultant orthopedic surgeons and orthopedic resident doctors. Details relating to the structure of training and challenges with training and recommendations for improved training were enquired. one hundred and two responses were received. There were 95% males (73) and 5% (4) females among the residents and 92% (23) males and 8% (2) females among the responding consultants. Of the residents, 47% (36) were registrars while 53% (41) were senior registrars. Seventy-six percent (77) were residents and twenty-five (24%) were consultants. Didactic lectures were the most impactful available training adjunct. Only 3% (2) of the residents had access to dry laboratory sessions with no specified number of practice hours attached. There was no computer simulation laboratory or cadaveric laboratory training facility for arthroscopy training in any of the training centres. Ninety-two percent (23) of the responding consultants would prefer a 6-12-month rotation in arthroscopy for residents. Fifty-three percent (41) of the residents had regular opportunities to participate in arthroscopic surgeries. orthopedic residency in arthroscopy in Nigeria is emerging and can be improved upon by increasing the available training resources and trained personnel.

Intussusception: Lab Report and Review of Literature

Objective: Intussusception is the invagination of a proximal portion of the gastrointestinal tract into an adjacent distal portion. This unusual form of bowel obstruction occurs less frequently in adults. We report a case of small bowel intussusception in a 39-year-old African male cadaver in the cadaveric laboratory in the, Department of Human Anatomy at, Uzima University. We have also performed a literature review of this rare condition. Method: Student cadaver groups at Uzima University were assigned with a ratio of 8:1 meaning that eight students received one cadaver to work on. There were a total of nine cadavers. One out of the nine assigned specimens had a lead point in the ileocecal valve resulting in ileocecal intussusception upon dissection. Results: At the ileocecal junction, an intussuscepted distal small bowel was discovered. We concluded it to be an ileocecal intussusception. Conclusion: The rarity of intussusception in adults makes it an exceptional finding in standard anatomy laboratory. Intussusception can occur anywhere in the gastrointestinal tract. Surgeons should consider intussusception as a severe cause of intestinal obstruction and consequently, anticipate different clinical presentations. Diagnosis of intussusception is difficult to make without surgery, therefore, surgeons need to familiarize themselves with different imaging modalities.

Comparison of Accessibility to Cavernous Sinus Areas Throughout Endonasal, Transorbital, and Transcranial Approaches: Anatomic Study With Quantitative Analysis.

The cavernous sinus (CS) is accessed through several approaches, both transcranially and endoscopically. The transorbital endoscopic approach is the newest proposed route in the literature. To quantify and observe the areas of the CS reach from 2 endoscopic and 1 transcranial approaches to the CS in the cadaver laboratory. Six CSs were dissected through endoscopic endonasal, transorbital endoscopic, and transcranial pterional approaches, with previous implanted references for neuronavigation during the dissection. Point registration was used to mark the CS exposure and limits through each approach for later area and volume quantification through a computerized technique. The endoscopic endonasal approach reaches most of the CS except part of the sinus's superior, lateral, and posterior regions. The area exposed through this approach was 210 mm 2 , and the volume was 1165 mm 3 . The transcranial pterional approach reached the superior and part of the lateral sides of the sinus, not allowing good access to the medial side. The area exposed through this approach was 306 m 2 , whereas the volume was 815 m 3 . Finally, the transorbital endoscopic approach accessed the whole lateral side of the sinus but not the medial one. The area exposed was the greatest, 374 m 2 , but its volume was the smallest, 754 m 3 . According to our results, the endonasal endoscopic approach is the direct route to access the medial, inferior, and part of the superior CS compartments. The transorbital approach is for the lateral side of the CS. Finally, the transcranial pterional approach is the one for the superior side of the CS.