User Tools

Site Tools


cadaveric_head

Cadaveric head

A growing body of literature describing use of high-fidelity surgical training models is challenging long-held dogma that cadavers provide the best medium for postgraduate surgical skills training.


A neurosurgical skills course for residents was structured to include 7 spinal and 3 cranial learning stations, each with its own model and assigned attending expert. Resident and attending neurosurgeons were asked to complete surveys on their overall impressions of the course and models, and on workload comparisons between models and real cases. Student t-tests were used for statistical comparisons.

Survey responses were collected from 9 of 16 participating residents (56.3%) and 3 of 10 attending neurosurgeons (30.0%). Both groups believed the course was very helpful overall to resident education. Respondents furthermore felt the course was more helpful overall than cadaveric courses. Task load index testing revealed no significant workload difference between models and real cases (P≥0.17), except in temporal demand (P<0.001).

Resident and attending neurosurgeons subjectively feel that high-fidelity synthetic models were superior to cadavers as a surgical skills teaching platform. This study raises the question of whether cadavers should remain the gold standard for surgical skills courses. Expanded use of these teaching models and further study are warranted 1).


Cadaveric head preparation is very important prior to dissection. The desired properties are: Good long-term structural preservation with minimal distortion, no desiccation, no bacterial or fungal growth, and minimal environmental chemical hazards 2).

The embalming fluid mixture used to preserve the cadaver is an important factor in achieving both good dissection properties, and long term preservation. Formaldehyde has been the main component in embalming fluids since the late 19th century due to its excellent preservation properties, low cost, and ready availability 3)

see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775188/

Adequate training based on cadaveric head dissection is essential to acquire a practical knowledge of surgical neuroanatomy and microsurgical/endoscopic dissection techniques.

Endoscopic procedures

Endoscopic procedures for the treatment of pathologies of the skull base are becoming increasingly common. The endoscopic training curve for tool handling and a detailed knowledge of the topographic anatomy of the skull base require intensive training on cadavers before approaching living patients, which is why cadaver laboratory experience should be mandatory for every resident and surgeon preparing to use microsurgical and endoscopic techniques.

Tschabitscher and Di Ieva describe the basic principles of the philosophy of anatomic dissection and the equipment necessary to set up an endoscopic cadaver laboratory 4).

1)
Bohl MA, McBryan S, Spear C, Pais Hs D, Preul MC, Wilhelmi B, Yeskel A, Turner JD, Kakarla UK, Nakaji P. Evaluation of a novel surgical skills training course: are cadavers still the gold standard for surgical skills training? World Neurosurg. 2019 Mar 28. pii: S1878-8750(19)30910-6. doi: 10.1016/j.wneu.2019.03.230. [Epub ahead of print] PubMed PMID: 30930320.
2)
Coleman R, Kogan I. An improved low-formaldehyde embalming fluid to preserve cadavers for anatomy teaching. J Anat. 1998;192:443–6.
3)
Mayer R. California: Appleton and Lange; 1990. Theory and Practice: Embalming.
4)
Tschabitscher M, Di Ieva A. Practical guidelines for setting up an endoscopic/skull base cadaver laboratory. World Neurosurg. 2013 Feb;79(2 Suppl):S16.e1-7. doi: 10.1016/j.wneu.2011.02.045. Epub 2011 Nov 7. Review. PubMed PMID: 22120404.
cadaveric_head.txt · Last modified: 2019/05/09 08:16 by administrador