Model of Arteriovenous Malformation Created in Human Placenta for Training in Vascular Microneurosurgery.

Autor:	Jiménez LÁC; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil., Salvagni FP; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil., Biondi-Soares LG; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil., Apaza-Tintaya RA; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil., Aguaisa EDT; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil., de Almeida IR; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil., Wuo-Silva R; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil., da Costa MDS; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil., Sarti THM; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil.; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil., Chaddad-Neto F; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil.; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil.
Jazyk:	angličtina
Zdroj:	Operative neurosurgery (Hagerstown, Md.) [Oper Neurosurg (Hagerstown)] 2024 Jul 30. Date of Electronic Publication: 2024 Jul 30.
DOI:	10.1227/ons.0000000000001305
Abstrakt:	Background and Objective: Arteriovenous malformations (AVMs) are congenital lesions, and because of their structure, complexity, flow, size, and location organization, they are lesions that require extensive anatomic knowledge and mastery of microsurgical skills and techniques. Human placentas as a training model for AVM surgery are promising alternatives. This article aims to describe the technique for forming an AVM-type lesion in human placentas and its usefulness in the training of microsurgical treatment techniques. Methods: In this study, 15 fresh human placental models were treated. A nidus was created using synthetic material, and dynamic flow was evaluated with intravascular injection of Indocyanine Green. The catheter system was connected to a continuous flow infusion pump. For simulation purposes, 4 vascular neurosurgeons and 4 vascular neurosurgery fellows used the same techniques and instruments used in real surgery to simulate the resection of AVM lesions. Subjective assessments were conducted, evaluating the validity and structured content on a 5-point Likert scale. Evaluation criteria included the execution of technical maneuvers and the model's expression and structural aspects. Results: We describe the step-by-step creation of an AVM in a placental biological model for the performance of vascular microsurgery training in the laboratory. We created in the human placenta a lesion with the characteristics of an AVM for microsurgical training in the laboratory, which presents key features realistic to a real AVM, such as 1 or more feeder arteries, nidus (synthetic), draining vein(s), continuous and pulsatile flow, and 3-dimensional configuration. Furthermore, it demonstrates the applicability of microsurgical techniques to the model compared with performing surgery on a patient. Conclusion: Considering it an effective method for laboratory training, the creation of arteriovenous malformations in human placentas enables students to replicate, comprehend the structure, and master microsurgical techniques in a realistic model. (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)
Databáze:	MEDLINE
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