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TissueDB/Simulators/Grapefruit Distal Anterior Cerebral Artery Bypass Simulator

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A pink grapefruit shown whole, halved, and in segments
A pink grapefruit shown whole, halved, and in segments. In the model the grapefruit stands in for the brain: two pole-to-pole rind incisions open a cavity that recreates the interhemispheric fissure, in which two vessels are anastomosed side-to-side. Image by א (Aleph), derivative by raeky, via Wikimedia Commons, CC BY-SA 3.0 (not from the source paper).

The Grapefruit Distal Anterior Cerebral Artery Bypass Simulator is a low-cost model, built from locally available materials, for practising side-to-side distal anterior cerebral artery (dACA) bypass — a deep, narrow-field microvascular anastomosis.[1] A large grapefruit is cut with two pole-to-pole rind incisions to open a cavity between its sections that recreates the deep interhemispheric fissure. Two vessels — chicken-wing brachial arteries or synthetic tubing — are placed parallel in the central column and joined side-to-side with 10-0 nylon under microscope magnification. An aquarium pump circulates dyed water through the vessels in a closed loop so an anastomotic leak is visible. The model requires no special laboratory facilities.

Field Details
Features and Basic Operation A submersible aquarium pump provides pulsatile circulation through the two vessels, making anastomotic leakage visible. The grapefruit provides a deep interhemispheric operative field, its sections can be retracted to reproduce the narrow surgical space, and either chicken-wing brachial arteries or synthetic tubing can be used as the vessel analogue.
Current Development Status Validated — Cikla et al. (2020) evaluated the grapefruit model with 12 board-certified neurosurgeons. The grapefruit model was rated a better replicate for cerebral artery bypass and more challenging than both a basic anastomosis training kit and a chicken-wing/thigh model. The study assessed perceived transfer of skills to surgery but did not report an observed transfer-to-surgery outcome.
Estimated Build Time and Cost
Build time: -; source-reported preparation time: grapefruit model 5–10 minutes; chicken-wing vessels add about 10 minutes
Cost: ~US$14–27 depending on vessel choice
Specialized Tools and Equipment An operating microscope for the anastomosis; a microsurgical instrument set for the 10-0 nylon suturing; a No. 11 scalpel for the rind incisions; scissors and tweezers to remove the chicken-wing skin and harvest the artery; forceps to remove the grapefruit stem; small retractors and small elastic stays to open and hold the grapefruit sections; and a temporary aneurysm-clip applier with mini titanium clips (the source used a Sugita T2 Titanium Clip System, Mizuho America) to occlude the vessels during suturing.
Version Version 1
Development Team Contact Information Developed by Ulas Cikla, Paul Rowley, Erik L. Jennings Simoes, Burak Ozaydin, Steven L. Goodman and Mustafa K. Baskaya (Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA), Nirav J. Patel (Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA) and Emel Avci (Neurological Surgery, Mersin University, Mersin, Turkey). Corresponding author: Mustafa K. Baskaya (baskaya@neurosurgery.wisc.edu).

Tissues

Tissue Qty Material Cost Notes
Skin 1 grapefruit (shared) Grapefruit rind and pith - Rind and pith represent skin and subcutaneous tissue in the operative approach.
Subcutaneous tissue 1 grapefruit (shared) Grapefruit rind and pith - Rind and pith represent skin and subcutaneous tissue in the operative approach.
Arachnoid mater and pia mater 1 grapefruit (shared) Thin grapefruit skin/pith layer - The thin layer over the outer grapefruit flesh represents the arachnoid mater and pia mater jointly.
Cerebral cortex 1 grapefruit (shared) Grapefruit flesh - The grapefruit flesh represents cerebral cortex. Tearing the flesh during the approach represents iatrogenic cortical injury.
Cerebral hemisphere 1 grapefruit section Grapefruit section - A grapefruit section represents a cerebral hemisphere.
Cerebral artery (pericallosal branches of the distal ACA) 2 Chicken-wing brachial arteries (5–6 cm segments), or 2 mm Silastic tubing US$1 for the chicken-wing vessel option; US$12 for Silastic tubing Paired donor and recipient vessel analogues for the side-to-side anastomosis. The grapefruit central core provides the path of the distal anterior cerebral artery. Silastic tubing reduces preparation time and is the higher-cost vessel option.

Structural Parts

Part Name Qty Material Cost Notes
Perfusion pump 1 Submersible aquarium pump, 80 GPH US$8 Drives the closed water-circulation loop. The source used a VicTsing 80 GPH pump. This is a reusable component.
Inflow and outflow lines 2 Adult nasal cannula, approximately 18 cm length (source used Medline Adult Soft-Touch) US$4 total The inflow cannula divides into two afferent channels entering the ventral pole; the outflow cannula returns fluid from the dorsal pole to the reservoir. These are reusable components.
Reservoir 1 Beaker or other container, 1 litre or larger - Holds approximately 250 mL of dyed water, the submerged pump and the returning fluid.
Stabilising base 1 Repurposed Styrofoam packaging, a small tray, a bowl, or a roll of duct tape - Stabilises the grapefruit for the surgical approach. The source lists these as alternative supports.

Consumables

Consumable Quantity Material Approximate Cost Notes
Cannulation stubs 4 Micropipette tips; IV angiocatheters are an alternative ~US$0.06 for micropipette tips Each vessel end is fitted over a 2.5 cm angiocatheter or similar pipette tip and secured with 3-0 nylon. Using IV angiocatheters instead increases the source-reported cost by about US$4 per training.
Anastomosis suture 1 pack 10-0 nylon - Used for the side-to-side vessel anastomosis.
Cannulation tie 1 pack 3-0 nylon - Secures each biologic vessel end to its cannulation stub.
Leak-indicator dye Trace Red food colouring - Added to the reservoir water to make leakage from the anastomosis visible.

Build Instructions

Build sequence from Cikla et al. (2020) Materials and Methods.

Phase 1: Prepare the grapefruit

  1. Choose a large grapefruit, 12–15 cm in diameter, and rest it on the stabilising base.
  2. Make two parallel pole-to-pole incision markings in the rind, axis to axis. The area between the outer markings should cover approximately one-fifth of the grapefruit surface.
  3. Cut along the outer markings with a No. 11 scalpel down to the border between the grapefruit pith and grapefruit skin. Do not cut into the flesh.
  4. Select one of the marked rind strips and slice it longitudinally to make a strip approximately 2 cm wide. Keep this strip for later placement over the vessels.
  5. Bluntly dissect between the grapefruit sections to open the cavity representing the interhemispheric fissure.

Verification: the cavity opens to the central column without tearing the grapefruit flesh.

Phase 2: Prepare and place the vessels

  1. For biologic vessels, remove the skin from a chicken wing with scissors and tweezers and harvest the brachial artery using the previously described chicken-wing method.[2] The extracted vessel is approximately 5–6 cm long. Remove the adventitia approximately 1 mm from each end. Fresh chicken-wing vessels provide better vessel quality than thawed vessels.
  2. Fit each vessel end over a 2.5 cm angiocatheter tip or similar micropipette tip and secure it with 3-0 nylon. Prepare two matched vessels. Self-cannulated 2 mm Silastic tubing can be used instead.
  3. Remove the grapefruit stem from the central column with forceps to clear the path for the vessels.
  4. Place the two vessels parallel to each other in the central-column cavity.
  5. Place the retained approximately 2 cm grapefruit-rind strip over the vessels with the pith side facing the vessels.

Verification: the two vessels are parallel and accessible in the central column.

Phase 3: Assemble the water circuit

  1. Connect the vessels to two nasal cannulas. Divide the ventral-pole cannula into two afferent channels, one for each vessel. Use the dorsal-pole cannula for the two efferent channels returning fluid to the reservoir.
  2. Add approximately 250 mL of water to a container of at least 1 litre. Add red food colouring.
  3. Submerge the 80 GPH aquarium pump in the reservoir and connect its outlet to the inflow cannula. The closed-circulation method follows the previously described Wisconsin model.[3]
  4. Turn on the pump and confirm closed-loop circulation.

Verification: fluid circulates through both vessels without leakage before bypass practice begins.

Phase 4: Bypass practice

  1. Place the grapefruit with the vessel-containing fissure facing the table. Approach from the opposite side.
  2. Carefully remove the thin layer over the outer grapefruit flesh that represents the arachnoid mater and pia mater.
  3. Clear the tissue above the natural groove between the two grapefruit sections and retract the sections with small retractors.
  4. Descend carefully toward the central column. Avoid tearing the grapefruit flesh, which represents cerebral cortex.
  5. Expose the paired vessels approximately 4 cm below the pith and hold the grapefruit sections apart with small elastic stays.
  6. Place temporary aneurysm clips proximal and distal to the planned bypass site on each vessel.
  7. Incise the occluded vessels and join them side-to-side with 10-0 nylon under the operating microscope.
  8. Remove the clips to restore circulation.
  9. Inspect the anastomosis. If dyed water leaks into the surrounding space, place additional sutures until the anastomosis no longer leaks.

Verification: with the clips removed, fluid passes through the vessels and the anastomosis does not leak into the surrounding grapefruit flesh.

Instrument care

  • Wash surgical instruments immediately after each simulation. Acidic grapefruit juice can corrode the instruments.

Not suitable for

  • Simulation requiring the viscosity and fluid behaviour of blood. The model uses water for circulation.
  • Simulation of vascular thrombosis. The model does not reproduce thrombosis.

References

  1. ↑ Cikla U, Rowley P, Jennings Simoes EL, Ozaydin B, Goodman SL, Avci E, Baskaya MK, Patel NJ. "Grapefruit Training Model for Distal Anterior Cerebral Artery Side-to-Side Bypass." World Neurosurgery. 2020;138:39–51. DOI: 10.1016/j.wneu.2020.02.107. PMID: 32109640.
  2. ↑ Hino A, Batjer HH, Schackert G, et al. "Training in microvascular surgery using a chicken wing artery." Neurosurgery. 2003;52:1495–1498. Chicken-wing brachial-artery harvesting method referenced by Cikla et al. (2020).
  3. ↑ Cikla U, Sahin B, Hanalioglu S, Ahmed AS, Niemann D, Baskaya MK. "A novel, low-cost, reusable, high-fidelity neurosurgical training simulator for cerebrovascular bypass surgery." J Neurosurg. 2018:1–9. Earlier Wisconsin closed-circulation method referenced by Cikla et al. (2020).
Simulator data
Alternative names grapefruit model
grapefruit training model
grapefruit bypass model


Page data
Keywords dACA bypass, distal anterior cerebral artery, side-to-side anastomosis, microvascular bypass, microsurgery training, grapefruit model, neurosurgery simulation, chicken wing brachial artery, low-cost simulator, Cikla, TissueDB
Authors Arturopelayo
License CC-BY-SA-4.0
Language English (en)
Related 0 subpages, 11 pages link here
Redirects TissueDB/Simulators/Grapefruit dACA Bypass Simulator
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Created April 12, 2026 by Arturo Pelayo
Last edit September 10, 2026 by StandardWikitext bot
Cite as Arturopelayo (2026). "TissueDB/Simulators/Grapefruit Distal Anterior Cerebral Artery Bypass Simulator". Appropedia. Retrieved September 13, 2026.
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