A human skull cast model for training of intracranial microneurosurgical skills

Skillful microsurgical techniques such as microvascular anastomosis and repair of nerves require dedicated and extensive laboratory training. Human microneurosurgery poses several additional technical difficulties, as the intracranial procedures are often performed through a narrow operative space at a considerable length, using knee-bend instruments. This article presents a laboratory model to simulate microneurosurgical procedures in humans. A human skull cast model made from plaster is cut such that, when placed on a operating table, it represents a standard position of a pterional approach and that the point of operation is at the same depth as the hypothetical circle of Willis. A standard pterional opening is made in de skull cast and the model is placed over the rat. Subsequently, all surgical procedures starting from tissue preparation to performing an arterial, venous, and/or nerve repair are performed with the cast over the rat using microneurosurgical knee-bent instruments and a surgical microscope. Microsurgical procedures such as end-to-end vessel anastomosis and nerve repair are technically much more challenging and difficult to execute when performed through the pterional opening of the human skull cast than without the cast model. Moreover, the cast model useful in training microsurgical techniques performed with long knee-bend instruments. It is concluded that the skull cast model represents a useful method to train intracranial microneurosurgical blood vessel anastomosis and nerve repair.