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Table of Contents    
Year : 2020  |  Volume : 68  |  Issue : 6  |  Page : 1479-1480

Simulation in Endovascular Neurosurgery Using Skull Bone: A Novel Concept

1 Division of Neurosurgery, Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
2 Radiodiagnosis, AIIMS, Bhubaneswar, Odisha, India

Date of Web Publication19-Dec-2020

Correspondence Address:
Dr. Chinmaya Dash
Division of Neurosurgery, Department of Trauma and Emergency, AIIMS, Bhubaneswar-751 019, Odisha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.304130

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How to cite this article:
Dash C, Mohakud S, Satapathy A, Sahu RN. Simulation in Endovascular Neurosurgery Using Skull Bone: A Novel Concept. Neurol India 2020;68:1479-80

How to cite this URL:
Dash C, Mohakud S, Satapathy A, Sahu RN. Simulation in Endovascular Neurosurgery Using Skull Bone: A Novel Concept. Neurol India [serial online] 2020 [cited 2021 Jan 21];68:1479-80. Available from:

Dear Editor,

Endovascular neurosurgery is a strongly imaging-dependent discipline. The precision and complication avoidance in such procedures depends on interaction of the interventionist with the imaging interface, as well as awareness of the biplane machine. Simulation techniques provide training of neurosurgical residents in targeted subspecialties, in a controlled manner without any risk to patients.[1],[2] Various simulators have been used to improve residency programs in endovascular neurosurgery.[3] However, they do not give hands-on experience in the Cath lab. We have devised an extremely low-cost method of providing hands-on experience to residents and technicians to various imaging sequence and image acquisition techniques in a Cath lab.

A skull bone that was split in the midsagittal plane was taken. Tubing of saline infusion set was taken and entry of tubing was done through foramen in the skull base. The tubing was coiled in the skull and the exit of the tube was connected to an empty saline bottle [Figure 1]a. A syringe with 20 ml contrast was taken. The skull bone was used as a dummy to learn centering in the frontal and lateral plane by the residents and technicians [Figure 1]b. The contrast was infused in the saline tube and various modes of the operator footswitch like fluoro/digital subtraction angiogram (DSA)/cine mode were practiced. A 3D rotation angiogram [Figure 2]a, DynaCT [Figure 2]b was performed using the same skull bone model. A used guidewire was used to pass through the saline tubing to learn the road map technique [Figure 2]c. Adequate measures to protect from radiation were taken by all participants. A pre and post-simulation feedback was obtained and the students/technicians were better versed with regard to handling the biplane machine and acquiring various imaging sequences and image acquisition techniques in a Cath lab, post the simulation procedure.
Figure 1: (a) Assembly consisting of saline bottle with infusion tubings, contrast, and skull bone. The infusion tubing is coiled within the skull bone and the exit of the tubing is done in an empty saline bottle. (b) Skull bone with tubing centered in the frontal plane

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Figure 2: (a) 3D rotational angiogram. (b) DynaCT image. (c) Tubing in road map mode along with the used guidewire in the tubing

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The authors describe a novel, simple yet cost-effective method for hands-on learning by residents and technicians in Cath lab for understanding the imaging acquisition techniques as well the operative technique of the bi-plane in a Cath lab. This method can be used in addition to the various described virtual reality simulation of neurointervention procedures, especially in the early phase of training to provide knowledge of operating the bi-plane Cath lab to residents and technicians.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Suri A, Patra DP, Meena RK. Simulation in neurosurgery: Past, present, and future. Neurology India 2016;64:387-95.  Back to cited text no. 1
Vilanilam GC, Kumar KK, Aggrawal V, Sudhir BJ, Nair P, Easwer HV, et al. Simulated neurosurgical reality: Could it fall short of the real thing? Neurol India 2016;64:1108-10.  Back to cited text no. 2
[PUBMED]  [Full text]  
Dardick J, Allen S, Scoco A, Zampolin RL, Altschul DJ. Virtual reality simulation of neuroendovascular intervention improves procedure speed in a cohort of trainees. Surg Neurol Int 2019;10:184.  Back to cited text no. 3


  [Figure 1], [Figure 2]


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