Simulation-based neurosurgical training for the presigmoid approach with a physical model.
BACKGROUND
In recent years, there has been growing interest in the use of simulation to supplement conventional surgical training. Simulation remains, however, in its infancy in neurosurgery.


OBJECTIVE
To report on and assess the utility of a simulation physical model for the presigmoid approach.


METHODS
The Congress of Neurological Surgeons created a Simulation Committee to explore and develop simulation-based models. The current model involves drilling of the presigmoid cranial base under image guidance. Each time the drill touches the dura, facial nerve, or sigmoid sinus, a beeping and a warning sound are emitted.


RESULTS
Nine neurosurgery residents participated in and completed the presigmoid approach simulation module. All residents successfully completed the simulation procedure within the allocated time period (20 minutes). The mean number of hits to the dura, facial nerve, and sigmoid sinus decreased from 4.2 in the first test to 3.1 in the second test (P < .05). The facial nerve was the most likely structure to be injured, followed by the sigmoid sinus and finally the dura. All 9 participants had an improvement in their technical scores.


CONCLUSIONS
The presigmoid approach simulation model is a useful tool in resident education that may improve surgical proficiency while minimizing risk to patients. More studies with standardized end points for technical proficiency and clinical outcomes are needed.
Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
Pascal
P
Jabbour
Nohra
N
Chalouhi
D002983:Clinical Competence; D003392:Cranial Sinuses / Q000601:surgery*; D006801:Humans; D007396:Internship and Residency; D008953:Models, Anatomic; D009493:Neurosurgery / Q000193:education* / Q000379:methods; D019635:Neurosurgical Procedures / Q000193:education* / Q000379:methods; D012886:Skull / Q000033:anatomy & histology / Q000601:surgery; D019291:Skull Base / Q000033:anatomy & histology / Q000601:surgery