Training Cerebrospinal Fluid Leak Repair with Nasoseptal Flap on the Lamb's Head

Abstract

Background: One of the major challenges of cranial base surgery is reconstruction of dural defects and cerebrospinal fluid leak closure. Various grafting methods have been used for smaller skull base defects with great success. The indications for endoscopic reconstruction have recently evolved to encompass much larger breeches in the skull base following tumor removal, thus emphasizing the need for vascularized tissue flaps for reconstruction. Methods: Some authors proposed a pedicled flap of the nasal septum mucoperiosteum and mucoperichondrium, which is very vascularized and has quite a large surface. It is also long enough to easily cover even larger defects of the skull base. The elevation of a nasoseptal flap is based on a particularly advanced surgical technique and thus requires proper training before being performed in a real patient. Results: Anatomical differences between human and lamb heads were observed and explained although they do not affect the procedure of the elevation of the nasoseptal flap. Conclusions: The lamb's head has been shown to be an ideal model for the adequate training of the surgical skills required for this demanding procedure.

Prospective transfrontal sheep model of skull‐base reconstruction using vascularized mucosa

“…We explored this approach in our cadaveric phase; however, the flap was not able to provide adequate length for coverage of the caudally positioned craniotomy when reflected over the frontal bones. There have been previous descriptions of endoscopic harvest of sheep nasoseptal flaps and this modification remains an area of further potential exploration in the future if an alternative inlay pathway could be used to completely cover the defect.…”

“…The sheep model has emerged as perhaps the most high‐fidelity model of human sinonasal anatomy in scale, architecture, and microanatomy . The purpose of this study was therefore to address the limitations of previous skull‐base reconstruction models through the development and validation of a novel, in vivo, prospective, transfrontal sheep model of cranial base repair using vascularized sinonasal mucosa.…”

Training model for endoscopic sinus surgery using lamb’s head

“…Our first step, eighteen years ago, when we started with lamb's head model, was detailed studying of the lamb's head surgical anatomy in cooperation with the academic stuff of the Department of Anatomy at the Veterinary Faculty in Zagreb [2]. Second, during two decades of the experience with the lamb's head, we do know that it offers the possibility of training not only septal surgery, middle antrostomy, ethmoidectomy and frontal sinus most anterior and most medial chamber presentation, but also more demanding and advanced procedures in human endoscopic sinus surgery (ESS) such as endoscopic endonasal orbital decompression [3], Draf 1, 2 and 3 procedures [4], cerebrospinal fluid (CSF) leak repair, including the nasoseptal flap [5] , and endonasal endoscopic dacryocystorhinostomy [6]. Besides, eight years ago a special head holder was projected by an architect, and later on produced by Karl Storz, Germany .…”

Rhino-Neurochirurgie

“…Für die ersten praktischen Trainingsschritte wurde ein simples, abstraktes Kunststoff-Modell der endoskopischen Hypophysenchirurgie entwickelt [387]. Ein in-vivo Tier-Modell am Schwein zur endoskopischen Hypophysenchirurgie wurde beschrieben [388], desgleichen ein in-vitro Modell am Schaf-Kopf zum Trai ning der endoskopisch gestützten Anlage naso-septaler Lappen [389] und ein abstraktes in-vivo Tiermodell an der Ratte für basale, endoskopisch kontrollierte Präparationstechniken [390]. Zum Training der weitergehenden Händigkeit wurde ein komplexes Modell an anatomischen humanen Frischpräparaten mit Simulation eines Tumorleidens durch Injektion von Polymeren etabliert [391,392].…”