Step-by-step education of the retrosigmoid approach leads to low approach-related morbidity through young residents.
BACKGROUND
Neurosurgery requires a profound knowledge of anatomy and surgical skills. The skull base approach is the crucial step for successful intradural performance. Resident training at experienced institutions must consider this background when educating young neurosurgeons.


METHODS
From 2006-2008, 223 retrosigmoid approaches for various cerebellopontine angle pathologies have been performed at the Department of Neurosurgery Eberhard-Karls-University, Tübingen. After a minimum time of 6 months assisting, followed by participation of dissection courses and continuous anatomical training, later performing their first approaches under direct supervision of an experienced surgeon, residents perform their first retrosigmoid approaches autonomously in the operating theatre. With this study, we evaluate the surgical morbidity and the time factor related to the educational level of the surgeon.


RESULTS
Comparing surgical-related morbidity between approaches performed by experienced neurosurgeons (>100 procedures) and young residents (<20 procedures), we found no significant differences concerning the incidence of cerebrospinal fluid fistulae, sinus lacerations, wound infections, cranioplasty dislocations, or occipital nerve neuromas. Even the mean time for the procedure (positioning, time-to-dural incision) was not significantly longer in the trainee group.


CONCLUSIONS
Respecting the stepwise educational levels for skull base surgery, including microanatomical studies, educational courses, and expert guidance at surgery, the retrosigmoid approach can be performed by young residents without increased morbidity at experienced institutions.
Ebner
Florian H
FH
Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Germany.
Dimostheni
Artemisia
A
Tatagiba
Marcos S
MS
Roser
Florian
F
D002526:Cerebellar Diseases / Q000601:surgery*; D002528:Cerebellar Neoplasms / Q000601:surgery*; D002530:Cerebellopontine Angle / Q000601:surgery*; D002983:Clinical Competence; D003392:Cranial Sinuses / Q000601:surgery; D003399:Craniotomy / Q000193:education; D003430:Cross-Sectional Studies; D003479:Curriculum; D004210:Dissection / Q000193:education; D005858:Germany; D006801:Humans; D007396:Internship and Residency; D009493:Neurosurgery / Q000193:education*; D010348:Patient Care Team; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies