Human Placenta Aneurysm Model for Training Neurosurgeons in Vascular Microsurgery

BACKGROUND: Neurosurgery, a demanding specialty, involves many microsurgical procedures that require complex skills, including open surgical treatment of intracranial aneurysms. Simulation or practice models may be useful for acquiring these skills before trainees perform surgery on human patients. OBJECTIVE: To describe a human placenta model for the creation and clipping of aneurysms. METHODS: Placental vessels from 40 human placentas that were dimensionally comparable to the sizes of appropriate cerebral vessels were isolated to create aneurysms of different shapes. The placentas were then prepared for vascular microsurgery exercises. Sylvian fissure-like dissection technique and clipping of large-and small-necked aneurysms were practiced on human placentas with and without pulsatile flow. A surgical field designed to resemble a real craniotomy was reproduced in the model. RESULTS: The human placenta has a plethora of vessels that are of the proper dimensions to allow the creation of aneurysms with dome and neck dimensions similar to those of human saccular and fusiform cerebral aneurysms. These anatomic scenarios allowed aneurysm inspection, manipulation, and clipping practice. Technical microsurgical procedures include simulation of sylvian fissure dissection, unruptured aneurysm clipping, ruptured aneurysm clipping, and wrapping; all were reproduced with high fidelity to the haptics of live human surgery. Skill-training exercises realistically reproduced aneurysm clipping. CONCLUSION: Human placenta provides an inexpensive, widely available, convenient biological tissue that can be used to create models of cerebral aneurysms of different morphologies. Neurosurgical trainees may benefit from the preoperative use of a realistic model to gain familiarity and practice with critical surgical techniques for treating aneurysms.