title: Shortening the learning curve in endoscopic endonasal skull base surgery: a reproducible polymer tumor model for the trans-sphenoidal trans-tubercular approach to retro-infundibular tumors.
abstract: BACKGROUND
  Endoscopic endonasal skull base surgery attracts an increasing number of young neurosurgeons. This recent technique requires specific technical skills for the approaches to non-pituitary tumors (expanded endoscopic endonasal surgery). Actual residents' busy schedules carry the risk of compromising their laboratory training by limiting significantly the dedicated time for dissections.
  
  
  OBJECTIVE
  To enhance and shorten the learning curve in expanded endoscopic endonasal skull base surgery, we propose a reproducible model based on the implantation of a polymer via an intracranial route to provide a pathological retro-infundibular expansive lesion accessible to a virgin expanded endoscopic endonasal route, avoiding the ethically-debatable need to hundreds of pituitary cases in live patients before acquiring the desired skills.
  
  
  METHODS
  A polymer-based tumor model was implanted in 6 embalmed human heads via a microsurgical right fronto-temporal approach through the carotido-oculomotor cistern to mimic a retro-infundibular tumor. The tumor's position was verified by CT-scan. An endoscopic endonasal trans-sphenoidal trans-tubercular trans-planum approach was then carried out on a virgin route under neuronavigation tracking.
  
  
  RESULTS
  Dissection of the tumor model from displaced surrounding neurovascular structures reproduced live surgery's sensations and challenges. Post-implantation CT-scan allowed the pre-removal assessment of the tumor insertion, its relationships as well as naso-sphenoidal anatomy in preparation of the endoscopic approach.
  
  
  CONCLUSIONS
  Training on easily reproducible retro-infundibular approaches in a context of pathological distorted anatomy provides a unique opportunity to avoid the need for repetitive live surgeries to acquire skills for this kind of rare tumors, and may shorten the learning curve for endoscopic endonasal surgery.
authors: Dardinger Microneurosurgical Skull Base Lab, Ohio State University Medical Center, Columbus, OH 43210, USA. berhouma.moncef@laposte.net
authors: Moncef
authors: M
authors: Berhouma
authors: Nishanta B
authors: NB
authors: Baidya
authors: Abdelhay A
authors: AA
authors: Ismaïl
authors: Jun
authors: J
authors: Zhang
authors: Mario
authors: M
authors: Ammirati
mesh_terms: D002102:Cadaver; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D007031:Hypothalamus / Q000033:anatomy & histology / Q000601:surgery; D059032:Learning Curve; D008953:Models, Anatomic; D009296:Nasal Cavity / Q000033:anatomy & histology* / Q000601:surgery*; D009493:Neurosurgery / Q000193:education*; D019635:Neurosurgical Procedures / Q000379:methods*; D011108:Polymers; D019291:Skull Base / Q000033:anatomy & histology* / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery*; D013100:Sphenoid Bone / Q000033:anatomy & histology / Q000601:surgery; D013788:Thalamus / Q000601:surgery*; D014057:Tomography, X-Ray Computed
chemical_list: D011108:Polymers
keywords: Endoscopic endonasal surgery; Laboratory training; Neurosurgical education; Retro-infundibular tumor; Skull base; Tumor model