• Marcelo Magaldi Oliveira, Leonardo Wendling, Jose Augusto Malheiros, Arthur Nicolato, Andre Prosdocimi, Luiza Guerra, Costa Pollyana H V PHV Placentarium, Federal University of Minas Gerais, Belo Horizonte, Brazil., Carlos Eduardo Ferrarez, Mauro Tostes Ferreira, Eric Sauvageau, and Ricardo Hanel.
• Placentarium, Federal University of Minas Gerais, Belo Horizonte, Brazil; Lyerly Neurosurgical Simulation Laboratory, Baptist Medical Center, Jacksonville, Florida, USA. Electronic address: mmagaldi@hotmail.com.
• World Neurosurg. 2018 Nov 1; 119: e694-e702.

BackgroundIntracranial-intracranial (IC-IC) bypass surgery involves the use of significant technical bimanual skills. Indications for this procedure are limited, so training in a simulator with brain vessels similarity could maintain microsurgical dexterity. Our goal is to describe the human placenta vascular anatomy to guide IC-IC bypasses apprenticeship.MethodsHuman placenta vascular anatomy was reported and validated with comparison to brain main vessels after studying the vascular tree of 100 placentas. Five simulated IC-IC bypasses (end to end, end to lateral, lateral to lateral, aneurysm bridge, and aneurysm exiting branch transposition) were developed and construct and concurrent validated. Statistical analysis using the t variance test was performed with a confidence interval of 0.95.ResultsA total of 1200 placenta vessels were used for test-retest validation with a reliability index of 0.95. All 100 human placentas were suitable to perform the 5 different bypasses. Construct validity showed a P < 0.005. Concurrent validity highlighted the technical differences among simulators.ConclusionsAn ex vivo bypass model offers great similarity to main brain vessels with the possibility to practice a variety of IC-IC bypass techniques in a single simulator. Placenta vascular anatomy knowledge can improve laboratory microsurgical training.Copyright © 2018 Elsevier Inc. All rights reserved.

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