The Identification of Factors That Influence the Quality of Bypass Anastomosis and an Evaluation of the Usefulness of an Experimental Practical Scale in This Regard

Hafez, Ahmad; Huhtakangas, Justiina; Muhammad, Sajjad; Lawton, Michael T.; Tanikawa, Rokuya; Niemelä, Mika

doi:10.1016/j.wneu.2018.09.031

Cited by 15 publications

(27 citation statements)

References 27 publications

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“…For problems requiring deep suturing, the surgical approaches tend to extend toward the skull base to obtain the corridor for bypass grafts to connect donors and recipient vessels in a more straightforward manner. 31 All of these can effectively improve the patency rate of anastomosis and reduce the stenosis of orifice.…”

Section: Bypass Technology and Experiencementioning

confidence: 99%

“…29 As a result of the risk of ischemia from occlusion of the PICA and perforators, the parent artery and perforators are preserved in patients with proximal PICA aneurysms. [30][31][32] Literature reports suggest the use of flow diversion for preserving parent vessel patency in patients with PICA aneurysms. But the inclusion of aneurysms in the study was most saccular.…”

Section: Microsurgery and Endovascular Surgerymentioning

confidence: 99%

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Bypass Surgery Management of Complex Proximal and Distal Posterior Inferior Cerebellar Artery Aneurysms

Zhao

Tong

2022

Journal of Craniofacial Surgery

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Background: For the complex posterior inferior cerebellar artery (PICA) aneurysms, standard microsurgical or endovascular technical options were not feasible. To determine the efficacy and outcomes of bypass surgery for complex PICA aneurysms, the authors herein review our recent surgical experience for complex PICA aneurysms. Methods: The authors retrospectively reviewed our experience of extracranial-intracranial bypass and intracranial-intracranial bypass surgery in treatment of proximal and distal complex PICA aneurysms at our institution from 2016 to 2020. Results: Twelve patients harboring 12 complex PICA aneurysms received bypass surgery at our institution. Seven (58.3%) patients with proximal PICA aneurysms underwent extracranial-intracranial bypass. Five (41.7%) patients with distal PICA aneurysms accepted intracranial-intracranial bypass. The postoperative symptom improvement: Of the 6 patients with preoperative hypoperfusion or ischemic of the cerebellar hemisphere, the symptom resolved in 5 patients, improved in 1 patient, of 5 patients with preoperative mass effect, the symptom resolved in 5 patients. During the follow-up period, ten patients had a modified Rankin scale (mRS) score of 0 to 1, and 1 patient had an mRS score of 2. One patient had an mRS score of 3. The long-term graft patency rate was 91.7%. All patients had no recurrence of intracranial aneurysm. Conclusions: Base on the complexity of anatomy structure and the vascular architecture, an individualized strategy was proposed for each patient. The use of different types of bypass procedures (occipital artery-PICA end-to-end bypass, PICA-PICA end-to-end anastomosis, and/or occipital artery graft) can safely and effectively manage these complex PICA aneurysms.

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Section: Bypass Technology and Experiencementioning

confidence: 99%

Section: Microsurgery and Endovascular Surgerymentioning

confidence: 99%

Bypass Surgery Management of Complex Proximal and Distal Posterior Inferior Cerebellar Artery Aneurysms

Zhao

Tong

2022

Journal of Craniofacial Surgery

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“…Hence, microvascular anastomosis techniques require dedicated and effective training to be mastered. Several training models, such as chicken wings, rats, placental vessels, human cadavers, and plastic tubing have been suggested for improving and refining microsurgical skills (2,(9)(10)(11)(12)(13)(14)(15). In the last years, virtual reality models and web-based simulators have also proved to be very powerful tools in enhancing trainees' learning experience at various levels (1,(16)(17)(18)(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

A novel, reusable, realistic neurosurgical training simulator for cerebrovascular bypass surgery: Iatrotek® bypass simulator validation study and literature review

D'Andrea

Musio²,

Colasanti³

et al. 2023

Front. Surg.

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BackgroundMicroanastomosis is a challenging technique requiring continuous training to be mastered. Several models have been proposed, but few effectively reflect a real bypass surgery; even fewer are reusable, most are not easily accessible, and the setting is often quite long. We aim to validate a simplified, ready-to-use, reusable, ergonomic bypass simulator.MethodsTwelve novice and two expert neurosurgeons completed eight End-to-End (EE), eight End-to-Side (ES), and eight Side-to-Side (SS) microanastomoses using 2-mm synthetic vessels. Data on time to perform bypass (TPB), number of sutures and time required to stop potential leaks were collected. After the last training, participants completed a Likert Like Survey for bypass simulator evaluation. Each participant was assessed using the Northwestern Objective Microanastomosis Assessment Tool (NOMAT).ResultsWhen comparing the first and last attempts, an improvement of the mean TPB was registered in both groups for the three types of microanastomosis. The improvement was always statistically significant in the novice group, while in the expert group, it was only significant for ES bypass. The NOMAT score improved in both groups, displaying statistical significance in the novices for EE bypass. The mean number of leakages, and the relative time for their resolution, also tended to progressively reduce in both groups by increasing the attempts. The Likert score expressed by the experts was slightly higher (25 vs. 24.58 by the novices).ConclusionsOur proposed bypass training model may represent a simplified, ready-to-use, reusable, ergonomic, and efficient system to improve eye-hand coordination and dexterity in performing microanastomoses.

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“…This ocular-independent visualization of the surgical field enables more comfortable and unconstrained working posture for the surgeon and allows a larger range of movements within the surgical field [ 1 , 3 , 9 ]. Moreover, the 3D visualization of the surgical field is similar for all participants of the surgery, which potentially improves surgical and anatomical education [ 3 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

3D Exoscopes in Experimental Microanastomosis: A Comparison of Different Systems

Hafez

Haeren

Huhtakangas

et al. 2023

Life

Self Cite

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Background: In recent years, three-dimensional exoscopes have been increasingly applied in neurosurgery. Multiple exoscopic systems are available, all offering specific features. In this study, we assessed practical and visualization performance of four different exoscopic systems in a highly challenging microsurgical procedure, and evaluated whether these affected the quality of work. Methods: We included four different exoscopes: Olympus ORBEYE, Zeiss KINEVO, Storz VITOM, and Aesculap AEOS. With each exoscope, ten experimental bypass procedures were carried out on chicken wing vessels at a depth of 3 cm. We evaluated the quality of the anastomoses, the practical considerations for the setup of the exoscopic systems, and the visualization quality by tracking the number of unnecessary movements. Results: All included exoscopes enabled us to perform the bypass procedures with mostly adequate or excellent results. Surgically, the most pronounced difference between the exoscopes was the duration of the procedure, which was mainly due to the number of unnecessary movements. Practically, the exoscopes differ highly which is important when considering which exoscope to apply. Conclusions: This is the first study comparing different exoscope systems while performing the same challenging microsurgical procedure. We found major practical differences between the exoscopes that determine the suitability of an exoscope based on the demands and conditions of the surgical procedure. Therefore, preprocedural practical training with the exoscope is required.

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The Identification of Factors That Influence the Quality of Bypass Anastomosis and an Evaluation of the Usefulness of an Experimental Practical Scale in This Regard

Abstract: There were advantages and disadvantages to both suturing techniques. The scale was a practical way to measure and improve performance.

Cited by 15 publications

References 27 publications

Bypass Surgery Management of Complex Proximal and Distal Posterior Inferior Cerebellar Artery Aneurysms

Bypass Surgery Management of Complex Proximal and Distal Posterior Inferior Cerebellar Artery Aneurysms

A novel, reusable, realistic neurosurgical training simulator for cerebrovascular bypass surgery: Iatrotek® bypass simulator validation study and literature review

3D Exoscopes in Experimental Microanastomosis: A Comparison of Different Systems

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