Middle Meningeal Artery Model for Training Endovascular Treatment of Chronic Subdural Hematomas in Interventional Neuroradiology

Abstract

Technical progress and the development of smaller treatment instruments allow neurointerventional procedures to be used to treat diseases involving small vessels (< 2 mm). One example is the subdural hematoma (SDH), which can be treated by embolizing the middle meningeal artery (MMA) to cut off blood supply to SDH. The procedure was first used in 2018, following efficacy and safety studies. The embolization is technically very challenging and requires extensive training of the physicians. This work presents the development of an MMA model for endovascular training simulations of SDH with original instruments and particle embolization for integration into the existing neurointerventional training simulator Hamburg ANatomical NEurointerventional Simulator (HANNES). The development and testing were carried out by an interdisciplinary team of physicians and engineers. The aim of this work is to avoid the disadvantages of animal experiments, such as ethical aspects, anatomical differences to human vessel architecture, and long-term availability. First, a printing study of the MMA model was carried out to determine suitable processes and materials. Subsequently, suitable models were tested by experienced neurointerventional physicians in a realistic treatment setting, whereby they assessed 4 out of 20 models as sufficiently good. Relevant criteria were, among others, the flowrate, probing ability, elasticity, haptics, and geometric mapping. Based on these findings, an embolization module was developed to capture particles during training, which was evaluated as a moderate basic model for SDH embolization training. In conclusion, the novel MMA model with embolization module integrated in the simulator HANNES enables an innovative state-of-the-art neurointerventional training opportunity of physicians.