<?xml version="1.0" encoding="utf-8"?>
<!DOCTYPE article SYSTEM "archivearticle3.dtd">
<article dtd-version="3.0" article-type="Invited Methods Article - JoVE Produced Video">
  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher">jove</journal-id>
      <journal-id journal-id-type="email">editorial-office@jove.com</journal-id>
      <journal-title-group>
        <journal-title>Journal of Visualized Experiments</journal-title>
      </journal-title-group>
      <issn pub-type="ppub">1940-087X</issn>
      <issn pub-type="epub"></issn>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">JoVE56809</article-id>
      <article-id pub-id-type="manuscript">JoVE56809</article-id>
      <article-categories>
        <subj-group subj-group-type="Article Type">
          <subject>Invited Methods Article - JoVE Produced Video</subject>
        </subj-group>
        <subj-group subj-group-type="Category">
          <subject>JoVE Medicine</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Development of a Cadaveric Multiport Model of Posterior Circulation Aneurysm Clipping for Neurosurgery and Otolaryngology Residents</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <role content-type="1" />
          <name>
            <surname>Gillham</surname>
            <given-names>Haley  Elizabeth</given-names>
          </name>
          <email>gillhamh@ohsu.edu</email>
          <xref ref-type="aff" rid="aff1" />
        </contrib>
        <contrib contrib-type="author">
          <role content-type="2" />
          <name>
            <surname>Lucke-Wold</surname>
            <given-names>Brandon</given-names>
          </name>
          <email>bwold@mix.wvu.edu</email>
          <xref ref-type="aff" rid="aff2" />
        </contrib>
        <contrib contrib-type="author">
          <role content-type="3" />
          <name>
            <surname>Dogan</surname>
            <given-names>Aclan</given-names>
          </name>
          <email>dogana@ohsu.edu</email>
          <xref ref-type="aff" rid="aff3" />
        </contrib>
        <contrib contrib-type="author">
          <role content-type="4" />
          <name>
            <surname>Cetas</surname>
            <given-names>Justin</given-names>
          </name>
          <email>cetasj@ohsu.edu</email>
          <xref ref-type="aff" rid="aff4" />
        </contrib>
        <contrib contrib-type="author">
          <role content-type="5" />
          <name>
            <surname>Cameron</surname>
            <given-names>William</given-names>
          </name>
          <email>cameronw@ohsu.edu</email>
          <xref ref-type="aff" rid="aff5" />
        </contrib>
        <contrib contrib-type="author" corresp="yes">
          <role content-type="6" />
          <name>
            <surname>Ciporen</surname>
            <given-names>Jeremy</given-names>
            <prefix>Dr.</prefix>
          </name>
          <degrees>MD FAANS</degrees>
          <email>ciporen@ohsu.edu</email>
          <xref ref-type="aff" rid="aff6" />
        </contrib>
        <contrib contrib-type="editor">
          <name>
            <surname>Navani</surname>
            <given-names>Dipesh</given-names>
          </name>
          <degrees>Ph.D.</degrees>
          <email>dipesh.n@jove.com</email>
          <xref ref-type="aff" rid="aff7" />
        </contrib>
        <aff id="aff1">
          <institution>Oregon Health and Science University</institution>
          <addr-line content-type="addrline1">3303 SW Bond Avenue</addr-line>
          <country>UNITED STATES</country>
          <addr-line content-type="city">Portland</addr-line>
          <addr-line content-type="state">OR</addr-line>
          <addr-line content-type="zipcode">97239</addr-line>
        </aff>
        <aff id="aff2">
          <institution>West Virginia University</institution>
          <addr-line content-type="addrline1">P.O. Box 9100</addr-line>
          <country>UNITED STATES</country>
          <addr-line content-type="city">Morgantown</addr-line>
          <addr-line content-type="state">WV</addr-line>
          <addr-line content-type="zipcode">26506-9600</addr-line>
        </aff>
        <aff id="aff3">
          <institution>Oregon Health and Science University</institution>
          <addr-line content-type="addrline1">3303 SW Bond Avenue</addr-line>
          <country>UNITED STATES</country>
          <addr-line content-type="city">Portland</addr-line>
          <addr-line content-type="state">OR</addr-line>
          <addr-line content-type="zipcode">97239</addr-line>
        </aff>
        <aff id="aff4">
          <institution>Oregon Health and Science University</institution>
          <addr-line content-type="addrline1">3303 SW Bond Avenue</addr-line>
          <country>UNITED STATES</country>
          <addr-line content-type="city">Portland</addr-line>
          <addr-line content-type="zipcode">97239</addr-line>
        </aff>
        <aff id="aff5">
          <institution>Oregon Health and Science University</institution>
          <addr-line content-type="addrline1">3303 SW Bond Avenue</addr-line>
          <country>UNITED STATES</country>
          <addr-line content-type="city">Portland</addr-line>
          <addr-line content-type="zipcode">97239</addr-line>
        </aff>
        <aff id="aff6">
          <institution>Oregon Health and Science University</institution>
          <institution content-type="position">Assistant Professor </institution>
          <institution content-type="dept">Neurological Surgery</institution>
          <addr-line content-type="addrline1">3303 SW Bond Ave </addr-line>
          <addr-line content-type="addrline2">CHH 8N </addr-line>
          <country>UNITED STATES</country>
          <addr-line content-type="city">Portland </addr-line>
          <addr-line content-type="state">Oregon</addr-line>
          <addr-line content-type="zipcode">97239</addr-line>
          <phone content-type="primary">916-612-3918</phone>
          <institution>Oregon Health and Science University</institution>
        </aff>
        <aff id="aff7">
          <institution>JoVE</institution>
          <addr-line>1 Alewife Center</addr-line>
          <addr-line>Suite 200</addr-line>
          <addr-line>Cambridge, MA  02140</addr-line>
          <country>UNITED STATES</country>
        </aff>
      </contrib-group>
      <history>
        <date date-type="received">
          <day>14</day>
          <month>06</month>
          <year>2017</year>
        </date>
        <date date-type="rev-recd">
          <day>30</day>
          <month>10</month>
          <year>2017</year>
        </date>
        <date date-type="rev-recd">
          <day>15</day>
          <month>09</month>
          <year>2017</year>
        </date>
        <date date-type="accepted">
          <day>10</day>
          <month>11</month>
          <year>2017</year>
        </date>
      </history>
      <abstract>
        <p>Posterior circulation aneurysms are difficult to treat with the current methods of coiling and clipping. To address limitations in training, we developed a cadaveric model to train learners on endoscopic clipping of posterior circulation aneurysms. An endoscopic transclival approach (ETA) and a transorbital precaruncular approach (TOPA) to successfully access and clip aneurysms of the posterior circulation is described. The model has flexibility in that a colored silicone compound can be injected into the cadaveric vessels for the purpose of training learners on vascular anatomy. The other option is that the model could be connected to a vascular perfusion pump allowing real-time appreciation of a pulsatile or ruptured aneurysm. This cadaveric model is the first of its kind for training of endoscopic clipping of posterior circulation aneurysms. Learners will develop proficiency in endoscopic skills, appropriate dissection, and appreciation for relative anatomy while developing an algorithm that can be employed in a real operative arena. Going forward, various clinical scenarios can be developed to enhance the realism, allow learners from different specialties to work together, and emphasize the importance of teamwork and effective communication.</p>
      </abstract>
      <kwd-group>
        <kwd>Posterior circulation aneurysm, neurosurgery simulation training, otolaryngology simulation training, endoscopic transclival approach, transorbital precaruncular approach, aneurysm clipping</kwd>
      </kwd-group>
      <funding-group />
      <counts>
        <fig-count count="0" />
      </counts>
      <custom-meta-group>
        <custom-meta>
          <meta-name>Please indicate whether this article will be Standard Access or Open Access. </meta-name>
          <meta-value>Standard Access (US$2,400);</meta-value>
        </custom-meta>
        <custom-meta>
          <meta-name>Please indicate the &lt;b&gt; full address&lt;/b&gt; at which this article will be &lt;b&gt;filmed&lt;/b&gt;.</meta-name>
          <meta-value>VirtuOHSU 3181 S.W. Sam Jackson Park Rd. Portland, Oregon 97239-3098</meta-value>
        </custom-meta>
        <custom-meta>
          <meta-name>If the invoicing address and point of contact are different than the corresponding author and filming address, please note the differences below.</meta-name>
          <meta-value>Jeremy Ciporen
3303 SW Bond Avenue
Portland, OR 97239</meta-value>
        </custom-meta>
        <custom-meta>
          <meta-name>Is all of the written text in your manuscript original (neither plagiarized nor self-plagiarized)? If using previously published figures, are re-use permissions from the previous publishers obtained and cited in the figure legends?</meta-name>
          <meta-value>Yes</meta-value>
        </custom-meta>
        <custom-meta>
          <meta-name>If this article is currently under review by another publication, please explain where.</meta-name>
          <meta-value>No</meta-value>
        </custom-meta>
        <custom-meta>
          <meta-name>Black and White Image Count</meta-name>
          <meta-value>0</meta-value>
        </custom-meta>
        <custom-meta>
          <meta-name>Color Image Count</meta-name>
          <meta-value>0</meta-value>
        </custom-meta>
        <custom-meta>
          <meta-name>Production Notes</meta-name>
          <meta-value>Surgery of human cadaver head.</meta-value>
        </custom-meta>
        <custom-meta>
          <meta-name>Acquisitions Editor</meta-name>
          <meta-value>Nandita Singh</meta-value>
        </custom-meta>
        <custom-meta>
          <meta-name>Assistant who entered lead</meta-name>
          <meta-value>Jennifer Carroll</meta-value>
        </custom-meta>
      </custom-meta-group>
    </article-meta>
  </front>
  <body>
    <fig>
      <label>1</label>
      <graphic xlink:href="Figure 1.pdf" xmlns:xlink="http://www.w3.org/1999/xlink" />
    </fig>
    <fig>
      <label>2</label>
      <graphic xlink:href="Figure 2.pdf" xmlns:xlink="http://www.w3.org/1999/xlink" />
    </fig>
    <fig>
      <label>3</label>
      <graphic xlink:href="Figure 3.pdf" xmlns:xlink="http://www.w3.org/1999/xlink" />
    </fig>
    <fig>
      <label>4</label>
      <graphic xlink:href="Figure 4.pdf" xmlns:xlink="http://www.w3.org/1999/xlink" />
    </fig>
    <table-wrap>
      <label>Table of Materials/Equipment</label>
      <graphic xlink:href="Posterior Circ Materials Final.xls" xmlns:xlink="http://www.w3.org/1999/xlink" />
    </table-wrap>
    <fig>
      <label>5</label>
      <graphic xlink:href="Figure 5.pdf" xmlns:xlink="http://www.w3.org/1999/xlink" />
    </fig>
    <table-wrap>
      <label>Table of Materials/Equipment</label>
      <graphic xlink:href="Posterior Circ Materials Revised.xls" xmlns:xlink="http://www.w3.org/1999/xlink" />
    </table-wrap>
    <fig>
      <label>Animated Figure (video and/or .ai figure files)</label>
      <graphic xlink:href="Media1.m4v" xmlns:xlink="http://www.w3.org/1999/xlink" />
    </fig>
    <fig>
      <label>6</label>
      <graphic xlink:href="Figure 6.pdf" xmlns:xlink="http://www.w3.org/1999/xlink" />
    </fig>
  </body>
</article>