Letter to the Editor Regarding: "Analysis of Endoscope-Assisted Retrosigmoid Approach versus Modified Transjugular Approach for Microvascular Decompression of the Facial Nerve: A Comparative Cadaveric Study".

Abstract

Microvascular decompression (MVD) is the standard surgical treatment for hemifacial spasm (HFS), with the retrosigmoid (RA) and modified transjugular (MTA) approaches being the most commonly used. Cadaveric models play a crucial role in neurosurgical training by providing anatomical accuracy and hands-on experience. However, traditional cadaveric models have notable limitations, including the absence of intraoperative bleeding, brain pulsations, and natural tissue elasticity, all of which reduce the realism of surgical simulations. Formalin fixation preserves tissue structure but increases stiffness, altering the tactile feedback essential for precise surgical maneuvers. Similarly, while silicone injection enhances vascular visualization, it does not simulate active bleeding, preventing trainees from practicing hemostatic techniques. Latex injection has been proposed as an alternative, offering better vessel flexibility and more realistic perfusion. Another key limitation is the lack of pulsatility, a critical factor in live surgeries where rhythmic vessel movements influence precision. Rumi Faizer's study on pulsatile cadaveric models demonstrated enhanced vascular training by improving realism in vessel handling and procedural execution. Applying similar pulsatile perfusion techniques to MVD training could create more dynamic simulations, allowing trainees to refine their skills in conditions that closely mimic live surgery. Incorporating fresh cadavers, latex perfusion, and pulsatile models into neurosurgical education could significantly enhance training fidelity, ensuring better preparedness and improved surgical outcomes.