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A morphometric and analytical cadaver dissection study of a tumor-simulation balloon model
Baran Bozkurt1, Evgenii Belykh2, Kaan Yağmurlu1
1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Abstract:
We quantified the effects on anatomical cadaver dissection of a balloon-inflation tumor model positioned in the parasellar region and approached through an orbitozygomatic (OZ) craniotomy. A modified supraorbital OZ was performed bilaterally on 5 silicon-injected cadaver heads. Ten predetermined anatomical points assigned using a frameless stereotactic device were used to measure the working area of exposure, degree of surgical freedom, and horizontal and vertical angles of attack to specific target points before and after inflation of a balloon catheter mimicking a parasellar tumor. Balloon inflation displaced the central anatomical structures (pituitary stalk, lamina terminalis, anterior chiasm, and internal carotid artery [ICA]-posterior communicating artery and ICA-A1 junctions) by 14-51% (p ≤ .05). With tumor simulation, the vertical angle of attack increased by 67% (p < .01), while the area of exposure increased by 83% (p < .01) and surgical freedom increased by 58% (p < .01). This tumor model also significantly displaced central anatomical sella-associated structures. Compared to a normal anatomical configuration, the tumor simulation (balloon) opened surgical corridors (especially vertical) and acted as a natural retractor, widening the angle of access to the infundibular apex-hypothalamic junction. Although this model cannot exactly mimic a tumor mass in a patient, the effects of tumor compression and sequential displacement of important structures can be combined into and then assessed in a cadaveric neurosurgical anatomical scenario for training and research.
Insights
A novel balloon model simulating parasellar tumors in cadavers improved surgical access via orbitozygomatic craniotomy. This approach enhanced working angles and exposure, aiding neurosurgical training and research.
Area of Science:
- Neurosurgery
- Anatomical Studies
- Surgical Simulation
Background:
- Parasellar region tumors present significant surgical challenges.
- Orbitozygomatic (OZ) craniotomy is a key approach for accessing this area.
- Accurate anatomical understanding is crucial for successful resection.
Purpose of the Study:
- To quantify the anatomical effects of a balloon-inflation tumor model in the parasellar region.
- To evaluate surgical access improvements using a modified supraorbital OZ craniotomy with this model.
- To assess the model's utility for neurosurgical training and research.
Main Methods:
- Bilateral modified supraorbital OZ craniotomies were performed on 5 silicon-injected cadaver heads.
- A balloon catheter mimicked a parasellar tumor, with inflation quantifying displacement.
- Frameless stereotaxy measured working area, surgical freedom, and angles of attack before and after balloon inflation.
Main Results:
- Balloon inflation displaced key anatomical structures (e.g., pituitary stalk, anterior chiasm, ICA junctions) by 14-51%.
- Tumor simulation significantly increased the vertical angle of attack (67%), area of exposure (83%), and surgical freedom (58%).
- The model effectively widened surgical corridors and acted as a natural retractor.
Conclusions:
- A balloon-inflation model effectively simulates parasellar tumor effects on anatomy.
- This simulation enhances surgical corridors and access, particularly vertically.
- The model provides a valuable cadaveric scenario for neurosurgical training and anatomical research.
