Training for brain tumour resection: a realistic model with easy accessibility.

Abstract

Resection of intrinsic and extrinsic brain tumours requires an understanding of sulcal and gyral anatomy, familiarity with tissue consistency and tissue manipulation. As yet, these skills are acquired by observation and supervised manipulation during surgery, thus accepting a potential learning curve at the expense of the patient in a live surgical situation. A brain tumour model could ensure optimised manual skills and understanding of surgical anatomy acquired in an elective and relaxed teaching situation. We report and evaluate a brain tumour model, regarding availability, realistic representation of sulcal and gyral anatomy and tissue consistency. Freshly prepared agar-agar solution with different concentrations was added with highlighter ink and injected into fresh sheep brains. Hardened agar-agar solution formed masses comparable to malignant brain tumours. Variation of the agar-agar concentration influenced diffusion of agar-agar solution in the adjacent brain tissue. Higher concentrated agar-agar solutions formed sharply delimitated masses mimicking cerebral metastases and lower concentrated agar-agar solutions tended to diffuse into the adjacent cerebral tissue. Adding highlighter ink to the agar-agar solution produced fluorescence after blue light excitation comparable to the 5-ALA induced fluorescence of malignant glioma. The described in vitro sheep brain tumour model is simple and realistic, available practically everywhere and cheap. Therefore, it could be useful for young neurosurgical residents to acquire basic neuro-oncological skills, experiencing properties of the cerebral brain texture and its haptic perception and to learn handling of neurosurgical equipment.