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Background and Purpose: We report on an intensive two-day training program on microanastomoses performed on perfused human placenta models. A specific scoring system was elaborated to evaluate the participants' microsurgical skills and report the participants' results., Materials and Methods: Trainees who attended the Zurich Microsurgery Courses in 2023 were included in the study. Before performing the microanastomoses, each participant received a visual didactic training. Training was made on perfused human placenta models. To perform the microvascular anastomoses, vessels of different diameters were chosen, and 9-0 and 10-0 microsutures were used. The course was structured in two days. On day one, participants practiced microvascular dissection, microsuturing and end-to-end anastomoses, while the second day was dedicated to end-to-side and to repeat the most useful microanastomosis depending on the specialty. A score system for the evaluation of a successful microanastomosis was developed and applied to assess the participants' anastomoses. User satisfaction was measured by means of a survey-based questionnaire., Results: Fifty-two participants from different institutions, specializations and levels of experience were included. A significant improvement in the overall microsurgical skills of the included cohort was documented (p < 0.005). The initial average score per anastomosis of 3.56 points (SD 0.71) increased to an average of 3.8 points (SD 0.87) at the end of the course. The steepest learning curve was observed in the placement of knots (Δ 0.48 points, p = 0.003) and microvascular dissection (Δ 0.44 points, p = 0.002). Most participants rated the fidelity and importance of the placental microsuturing course as extremely high., Conclusion: The two-day training program is efficient to teach microvascular dissection and microanastomosis techniques. A significant improvement of participants' microsurgical skills was reported. The human placenta model proved to be a high-fidelity simulator with great user satisfaction., Competing Interests: Declarations Ethical approval The use of each placenta at the Zurich Microsurgery Course required presence of a written consent for imaging and biologic data use signed by the mother. The trainees at the Zurich Microsurgery Courses participated voluntarily to the study and no consent was signed. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Perfused placentas provide an excellent and accessible model for microvascular dissection, microsuturing and microanastomosis training - particularly in the early microsurgical learning curve. This way, a significant amount of live animals can be spared., Method: We present the Zurich Microsurgery Lab protocol, detailing steps for obtaining, selecting, cleaning, flushing, cannulating, and preserving human placentas - as well as microsurgical training examples - in a tried-and-true, safe, cost-effective, and high-yield fashion., Conclusion: Our technique enables highly realistic microsurgical training (microdissection, microvascular repair, microanastomosis) based on readily available materials. Proper handling, preparation, and preservation of the perfused placenta models is key., (© 2023. The Author(s).)

Background: The decision to treat unruptured intracranial aneurysms (UIAs) or not is complex and requires balancing of risk factors and scores. Machine learning (ML) algorithms have previously been effective at generating highly accurate and comprehensive individualized preoperative predictive analytics in transsphenoidal pituitary and open tumor surgery. In this pilot study, we evaluate whether ML-based prediction of clinical endpoints is feasible for microsurgical management of UIAs., Methods: Based on data from a prospective registry, we developed and internally validated ML models to predict neurological outcome at discharge, as well as presence of new neurological deficits and any complication at discharge. Favorable neurological outcome was defined as modified Rankin scale (mRS) 0 to 2. According to the Clavien-Dindo grading (CDG), every adverse event during the post-operative course (surgery and not surgery related) is recorded as a complication. Input variables included age; gender; aneurysm complexity, diameter, location, number, and prior treatment; prior subarachnoid hemorrhage (SAH); presence of anticoagulation, antiplatelet therapy, and hypertension; microsurgical technique and approach; and various unruptured aneurysm scoring systems (PHASES, ELAPSS, UIATS)., Results: We included 156 patients (26.3% male; mean [SD] age, 51.7 [11.0] years) with UIAs: 37 (24%) of them were treated for multiple aneurysm and 39 (25%) were treated for a complex aneurysm. Poor neurological outcome (mRS ≥ 3) was seen in 12 patients (7.7%) at discharge. New neurological deficits were seen in 10 (6.4%), and any kind of complication occurred in 20 (12.8%) patients. In the internal validation cohort, area under the curve (AUC) and accuracy values of 0.63-0.77 and 0.78-0.91 were observed, respectively., Conclusions: Application of ML enables prediction of early clinical endpoints after microsurgery for UIAs. Our pilot study lays the groundwork for development of an externally validated multicenter clinical prediction model.

The concomitant presence of an aneurysm in contact with a sellar lesion usually contraindicates a transsphenoidal approach (TSS). Clipping of an intracranial aneurysm is however possible in highly selected cases also through an endoscopic TSS approach, as long as the basic principles of cerebrovascular surgery are respected. We report thus on a case of a patient harboring a Rathke cleft cyst (RCC) and an aneurysm of the carotid artery (ICA) in close contact with the RCC. The anatomical characteristics of both lesions warranted an endoscopic TSS for removal of the RCC and clipping of the aneurysm during the same approach.