Simulated spinal cerebrospinal fluid leak repair: an educational model with didactic and technical components.
BACKGROUND
In the era of surgical resident work hour restrictions, the traditional apprenticeship model may provide fewer hours for neurosurgical residents to hone technical skills. Spinal dura mater closure or repair is 1 skill that is infrequently encountered, and persistent cerebrospinal fluid leaks are a potential morbidity.


OBJECTIVE
To establish an educational curriculum to train residents in spinal dura mater closure with a novel durotomy repair model.


METHODS
The Congress of Neurological Surgeons has developed a simulation-based model for durotomy closure with the ongoing efforts of their simulation educational committee. The core curriculum consists of didactic training materials and a technical simulation model of dural repair for the lumbar spine.


RESULTS
Didactic pretest scores ranged from 4/11 (36%) to 10/11 (91%). Posttest scores ranged from 8/11 (73%) to 11/11 (100%). Overall, didactic improvements were demonstrated by all participants, with a mean improvement between pre- and posttest scores of 1.17 (18.5%; P = .02). The technical component consisted of 11 durotomy closures by 6 participants, where 4 participants performed multiple durotomies. Mean time to closure of the durotomy ranged from 490 to 546 seconds in the first and second closures, respectively (P = .66), whereby the median leak rate improved from 14 to 7 (P = .34). There were also demonstrative technical improvements by all.


CONCLUSIONS
Simulated spinal dura mater repair appears to be a potentially valuable tool in the education of neurosurgery residents. The combination of a didactic and technical assessment appears to be synergistic in terms of educational development.
*Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; ‡Department of Orthopedics, University of Wisconsin, Madison, Wisconsin; §Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
George M
GM
Ghobrial
Paul A
PA
Anderson
Rohan
R
Chitale
Peter G
PG
Campbell
Darlene A
DA
Lobel
James
J
Harrop
D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D002983:Clinical Competence; D004388:Dura Mater / Q000601:surgery; D004521:Educational Measurement; D006801:Humans; D007396:Internship and Residency; D007796:Laminectomy; D008953:Models, Anatomic; D019635:Neurosurgical Procedures / Q000193:education* / Q000379:methods*