A simple yet effective training model for mastering deep bypass procedures

The acquisition of fine motor skills crucial for neurosurgical bypasses relies heavily on repetition. While conventional practice models adequately prepare surgeons for superficial anastomoses, they fall short when it comes to deep bypasses through skull base corridors, and realistic training setups are complex and expensive. In this study, we present a novel training concept that combines realism and simplicity, enabling virtually unlimited practice of deep anastomoses. Our training setup comprised a binocular microscope, inexpensive microsurgical instruments, vessels sourced from chicken wings, and a commercially available 3D brain-skull model not originally intended for microanastomosis training. By securing "recipient" chicken vessels to the plastic vessels within the model and employing standard techniques to anastomose them with "donor" chicken vessels in the surgical field, we created a simulation of deep neurosurgical bypasses. With minimal preparation, we successfully replicated complex neurosurgical bypasses such as STA-PCA, PCA-SCA, and A1-graft-MCA. To our knowledge, no comparable training method in terms of realism, simplicity, and affordability exists in the literature. We present a cost-effective, straightforward, and realistic training approach that facilitates individual practice of deep bypasses at a high frequency. Its simplicity makes it replicable even in resource-limited settings.