Evaluation of a Cerebrospinal Fluid and Blood-Perfused Cadaveric Model in Neurosurgical Simulation Training

In skull base neurosurgery, the pterional approach is of particular importance for many indications. These approaches are challenging for young inexperienced neurosurgeon. That is why training on realistic model is a true added value. We aimed to develop and pedagogically evaluate a revascularized cadaveric model combining pulsatile arterial perfusion with restoration of cerebrospinal fluid pressure. The model was designed to simulate a frontopterional approach, subarachnoid dissection, and exposure of the circle of Willis. It also aimed to reproduce the management of an intracranial carotid artery injury.

Sixteen neurosurgical residents completed 3 simulation using freshly preserved cadavers perfused with the SIMLIFE system (synthetic blood perfusion through common carotid arteries) and intracranial pressure restauration through cerebrospinal fluid perfusion. The model was assessed using Kirkpatrick's framework: Realism (level 1), Self-reported confidence (level 2), and Objective technical performance including blinded video analysis, bleeding duration and volume, and nontechnical skills such as communication and stress management (level 3).

Anatomic and physiological realism were rated highly. Significant improvement in self-confidence was observed for most surgical steps. Blinded video analysis did not demonstrate a statistically significant global improvement, largely because of substantial intercadaver variability affecting brain consistency and vascular patency.

This revascularized cadaveric model provides a high-fidelity simulation strongly appreciated by trainees. It significantly enhances confidence in performing a complex skull base and vascular approaches. Optimization of cerebral fixation and vascular consistency could improve reproducibility and enable more accurate measurement of technical progress.