Objective Validation of Perfusion-Based Human Live Cadaveric Simulation Training Model for Management of Internal Carotid Artery Injury in Endoscopic Endonasal Sinus and Skull Base Surgery

Objective To assess the face and content validity of an innovative perfusion-based cadaveric model developed to simulate internal carotid artery (ICA) injury during endoscopic surgery.

Methods Otolaryngology and neurosurgery trainees attempted three consecutive trials of endoscopic control of a parasellar ICA injury, with standardized technical feedback. Time to hemostasis (TTH) and blood loss were trended. All participants completed validated questionnaires using a five-point Likert scale to assess the domains of confidence gain, face validity, content validity, and curriculum applicability.

Results Among all participants (n = 35), TTH and mean blood loss significantly decreased between first versus second attempt (p = 0.005), and first versus third attempt (p = 0.03). Following the first attempt, trainees experienced an average 63% reduction in blood loss and 59% reduction in TTH. In the quartile of most improved participants, average blood loss reduction was 1,115 mL (84% reduction) and TTH of 259 seconds (84% reduction). There were no significant differences between trainees of varying postgraduate year or specialty. Average pre- and post-procedural confidence scores were 1.38 and 3.16, respectively (p < 0.0001). All trainees reported model realism, which achieved mean face validity 4.82 ± 0.41 and content validity 4.88 ± 0.33.

Conclusion The perfusion-based human cadaveric ICA injury model achieves high ratings of face and content validity across all levels of surgical trainees, and enables safe, realistic simulation for standardized skull base simulation, and future curriculum development. Objective improvements in performance metrics may translate to improved patient outcomes.