{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T10:56:53Z","timestamp":1789037813501,"version":"build-2803163510"},"reference-count":19,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,3,18]],"date-time":"2019-03-18T00:00:00Z","timestamp":1552867200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Internal carotid artery injury (ICAI) is a rare, life\u2010threatening complication of endoscopic endonasal approaches (EEAs). High\u2010fidelity simulation methods exist, but optimization of the training cohort, training paradigm, and costs of simulation training remain unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using our previously validated, high\u2010fidelity, perfused\u2010cadaver model, participants attempted to manage a simulated ICAI. After a brief instructional video and coaching, the simulation was repeated. Training success was defined as successful ICAI control on the second attempt after failure on the initial attempt. Marginal costs were measured.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy\u2010two surgeons participated in the standardized simulation, which lasted \u226415 minutes. The marginal cost of simulation was $275.00 per surgeon. A total of 44.4% (n = 32) succeeded on the first attempt before training (previously proficient); 44.4% (n = 32) failed the first attempt, but succeeded after training (training successes); and 11.1% (n = 8) failed both attempts. The cost per training success was $618.75. Forty\u2010two surgeons had never treated an ICAI, with 24 becoming training successes (57.1% overall, 82.8% when excluding previously proficient surgeons). Twenty\u2010nine had experienced a real or simulated ICAI, with 8 (27.6% overall, 72.7% excluding previously proficient surgeons) becoming training successes. The cost per training success was lowest in the ICAI\u2010naive group ($481.25) and highest among surgeons with simulated and real ICAI experience ($1650).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Surgeons can be trained to manage ICAI in a single, brief, low\u2010cost session. Although all groups improved, training an ICAI\u2010naive or resident cohort may maximize training results. A perfused\u2010cadaver model is a reproducible, realistic, and low\u2010cost method for training surgeons to manage life\u2010threatening ICAI during an EEA.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.22319","type":"journal-article","created":{"date-parts":[[2019,3,19]],"date-time":"2019-03-19T03:57:12Z","timestamp":1552967832000},"page":"787-794","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Costs and training results of an objectively validated cadaveric perfusion\u2010based internal carotid artery injury simulation during endoscopic skull base surgery"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0531-1436","authenticated-orcid":false,"given":"Daniel A.","family":"Donoho","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Keck School of Medicine University of Southern California  Los Angeles CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cali E.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Surgery, Keck School of Medicine University of Southern California  Los Angeles CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7016-4375","authenticated-orcid":false,"given":"Kevin T.","family":"Hur","sequence":"additional","affiliation":[{"name":"Tina and Rick Caruso Department of Otorhinolaryngology\u2012Head and Neck Surgery, Keck School of Medicine University of Southern California  Los Angeles CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian A.","family":"Buchanan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Keck School of Medicine University of Southern California  Los Angeles CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vance L.","family":"Fredrickson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Keck School of Medicine University of Southern California  Los Angeles CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Minneti","sequence":"additional","affiliation":[{"name":"Department of Surgery, Keck School of Medicine University of Southern California  Los Angeles CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Zada","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Keck School of Medicine University of Southern California  Los Angeles CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bozena B.","family":"Wrobel","sequence":"additional","affiliation":[{"name":"Tina and Rick Caruso Department of Otorhinolaryngology\u2012Head and Neck Surgery, Keck School of Medicine University of Southern California  Los Angeles CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,3,18]]},"reference":[{"key":"e_1_2_6_2_1","article-title":"Carotid canal and optic canal at sphenoid sinus","author":"Asal N","journal-title":"Neurosurg Rev"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajr.2007.21.2901"},{"issue":"2","key":"e_1_2_6_4_1","first-page":"ons261","article-title":"Carotid artery injury during endoscopic endonasal skull base surgery: incidence and outcomes","volume":"73","author":"Gardner PA","year":"2013","journal-title":"Neurosurgery"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1009951917649"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-199702000-00001"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21471"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0031-1275255"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26181"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1372470"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.20033"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21941"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/ons\/opx074"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/ons\/opx262"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2832"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/ons\/opx035"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.3171\/2014.12.JNS141551"},{"key":"e_1_2_6_18_1","unstructured":"Perfusion.Com. 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