Development and validation of a preclinical model for training and assessment of cerebrospinal fluid leak repair in endoscopic skull base surgery

Mattavelli, Davide; Ferrari, Marco; Rampinelli, Vittorio; Schreiber, Alberto; Buffoli, Barbara; Deganello, Alberto; Rodella, Luigi Fabrizio; Fontanella, Marco Maria; Nicolai, Piero; Doglietto, Francesco

doi:10.1002/alr.22451

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…Although ENT surgeons are directly involved in the surgical procedure, neurosurgeons are necessarily involved to manage and choose complex dural and intracranial reconstruction and to treat eventual complications. Therefore, surgeons need intensive training to acquire surgical skills and experience 50,51 . To date, no adequate risk stratification to outline reconstructive algorithms still exist.…”

Section: Discussionmentioning

confidence: 99%

Management of cerebrospinal fluid leak: the importance of multidisciplinary approach

Galli

Morelli

Rigante

et al. 2021

Acta Otorhinolaryngol Ital

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Cerebrospinal fluid (CSF) leak remains a rare condition, characterized by serious complications and potentially fatal. According to different etiologies, CSF leaks may be classified into two main categories: traumatic and spontaneous. Spontaneous fistulas seem to be mainly related to obesity and idiopathic intracranial hypertension. Diagnosis is both clinical and radiological. During the last three decades, surgical treatment has mostly shifted to endonasal endoscopic approach, which widely demonstrated to be more effective than invasive intracranial ones. Post-operative complications, long-term sequelae and hospital stay are strongly reduced thanks to endoscopic approach. The diagnosis and treatment of CSF leaks represent a difficult and challenge task. The main effort seems to be related to the precise localization of the leak. An accurate assessment of both predisposing factors and comorbidities is mandatory in case of spontaneous leaks. However, a clinical multidisciplinary evaluation as well as treatment, is essential to decrease the rate of failure of surgery. The presence of a dedicated instruments, the Skull Base Team, the knowledge of reconstructive materials and techniques represents a decisive result in therapeutical management even if for each patient an effective therapeutic algorithm can be obtained considering the correct leak detection and characteristics. In conclusion the strict teamwork with neurosurgeons, neuroradiologists, ophtalmologists will enable the development also of innovative biomaterials, which could spread and standardize multi-layer techniques, nowadays still related to surgeon preferences.

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Section: Discussionmentioning

confidence: 99%

Management of cerebrospinal fluid leak: the importance of multidisciplinary approach

Galli

Morelli

Rigante

et al. 2021

Acta Otorhinolaryngol Ital

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“…Later, Mattavelli et al reported a similar preclinical model, in which they measured CSFL pressure points. 11 Some limitations exist concerning this model. First, the studied group was not compared to a control group that can use other CSFL models.…”

Section: Discussionmentioning

confidence: 99%

“…reported a similar preclinical model, in which they measured CSFL pressure points. 11…”

Section: Discussionmentioning

confidence: 99%

“…6,7 However, limited simulation models exist for skull base surgery, especially for CSFL repair. [8][9][10][11] A CSFL repair simulation model has been designed to train surgeons and facilitate the acquisition of the fundamental skills necessary for skull base reconstruction. 10 The feasibility of the model has been examined and published previously.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 However, limited simulation models exist for skull base surgery, especially for CSFL repair. 8–11…”

Section: Introductionmentioning

confidence: 99%

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Cerebrospinal Fluid Leak Repair Simulation Model: Face, Content, and Construct Validation

Alqahtani

Albathi

Castelnuovo

et al. 2020

Am J Rhinol�Allergy

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Background Cerebrospinal fluid leak (CSFL) repair simulation models are scarce; however, these models are valuable tools for skull base reconstruction surgery training. Objectives This study aims to assess the face, content, and construct validity of a CSFL repair simulation model. Method Eight novices (residents- PGY3) and eight experts have performed skull base reconstruction in multiple sites in twelve human cadaveric heads in simulated surgical environment. The experts completed a post-study 21-item questionnaire to assess the face and content validity. The performances of the participants were recorded and scored by two independent investigators who were blinded to the participant's level. Global Rating Scale of Operative Performance (GRSOP) and a Specific Skull Base Reconstruction Checklist (SBRC) were used to score the performances. Results The responses from the expert group for the 21-item questionnaire were high for all items (4.13–4.88 out of 5). The internal consistency reliability of the questionnaire and the intraclass correlation, which was derived by Cronbach’s Alpha, were 0.913 and 0.941 respectively. Differences in construct validity between the two groups were statistically significant for both the GRSOP and SBRS (P-value < 0.001). Conclusion We demonstrated the face, content, and construct validity of the CSFL repair simulation model, which facilitates the acquisition of technical skills necessary for skull base reconstruction surgery. The model includes realistic features that make it useful in educational courses.

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Simulation training in endoscopic skull base surgery: A scoping review

James

Irace

Gudis

et al. 2022

World j. otorhinolaryngol.-head neck surg.

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Objective Proficiency in endoscopic endonasal skull base surgery requires both substantial baseline training and progressive lifelong learning. Endoscopic simulation models continue to evolve in an effort to optimize trainee education and preoperative preparation and improve surgical outcomes. The current scoping review systematically reviews all available literature and synthesizes the current paradigms of simulation models for endoscopic skull base surgery training and skill enhancement. Methods In accordance with Preferred Reporting Items for Systemic Review and Meta‐Analyses guidelines, we systematically searched PubMed, Embase, CINAHL, and Cochrane databases. Studies were categorized according to the type of simulation models investigated. Results We identified 238 unique references, with 55 studies ultimately meeting inclusion criteria. Of these, 19 studies described cadaveric dissection models, 17 discussed three‐dimensional (3D) printed models, 14 examined virtual surgical planning and augmented reality‐based models, and five 5 articles described task trainers. Conclusions There are a wide variety of simulation models for endoscopic skull base surgery, including high‐fidelity cadaveric, virtual reality, and 3D‐printed models. These models are an asset for trainee development and preoperative surgical preparation.

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Development and validation of a preclinical model for training and assessment of cerebrospinal fluid leak repair in endoscopic skull base surgery

Cited by 9 publications

References 13 publications

Management of cerebrospinal fluid leak: the importance of multidisciplinary approach

Management of cerebrospinal fluid leak: the importance of multidisciplinary approach

Cerebrospinal Fluid Leak Repair Simulation Model: Face, Content, and Construct Validation

Simulation training in endoscopic skull base surgery: A scoping review

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