Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
General Surgery, University of Southern California, Los Angeles, California.
Oper Neurosurg (Hagerstown). 2018 Jan 1;14(1):72-80. doi: 10.1093/ons/opx074.
Novel methodologies providing realistic simulation of the neurosurgical operating room environment are currently needed, particularly for highly subspecialized operations with steep learning curves, high-risk profiles, and demands for advanced psychomotor skills.
To describe the development of a curriculum for using perfusion-based cadaveric simulation models in a "Mock Operating Room" for neurosurgical procedures.
At the USC Keck School of Medicine Fresh Tissue Dissection Laboratory between 2012 and 2016, 43 cadaveric specimens underwent cannulation of the femoral or carotid artery and artificial perfusion of the arterial system, and/or cannulation of the intradural cervical spine for intrathecal reconstitution of the cerebrospinal fluid (CSF) system. Models were used to train neurosurgical residents in various procedures. Self-assessment of pre- and postprocedure trainee confidence (Likert) scores was compared for each module.
The following novel procedural training methodologies were successfully established: management of an injury to the carotid artery during an endoscopic endonasal approach (n = 12), endoscopic endonasal CSF leak repair (n = 6) with fluorescein perfusion, carotid endarterectomy (n = 4), extracranial-to-intracranial bypass (n = 2), insertion of ventriculostomy catheter (n = 7), spinal laminectomy with durotomy repair (n = 9), and intraventricular neuro-endoscopy with septum pellucidotomy and third ventriculostomy (n = 12). In all instances, trainees reported improvement in their postprocedural confidence scores, with mean pre- and postprocedural Likert scores being 2.85 ± 1.09 and 4.14 ± 0.93 (P < .05).
Augmentation of fresh cadaveric specimens via reconstitution of vascular and CSF pathways is a feasible methodology for complimenting surgical training in numerous neurosurgical procedures, and may hold implications in the future of neurosurgical resident education.
目前需要新的方法来模拟神经外科手术室环境，特别是对于那些学习曲线陡峭、风险高、需要高级运动技能的高度专业化手术。
描述在“模拟手术室”中使用基于灌注的尸体模拟模型进行神经外科手术的课程开发。
在 2012 年至 2016 年期间，在南加州大学凯克医学院新鲜组织解剖实验室，43 具尸体标本进行了股动脉或颈动脉插管和动脉系统人工灌注，和/或进行了硬脊膜内颈椎插管，以重建脑脊液（CSF）系统。使用模型对神经外科住院医师进行了各种程序的培训。比较了每个模块中术前和术后培训师信心（Likert）评分的自我评估。
成功建立了以下新的程序培训方法：内镜经鼻入路中颈动脉损伤的处理（n=12）、荧光素灌注内镜经鼻 CSF 漏修复（n=6）、颈动脉内膜切除术（n=4）、颅外-颅内旁路（n=2）、脑室造瘘管插入（n=7）、脊髓椎板切除术和硬脑膜切开术修复（n=9）、脑室神经内镜检查伴有透明隔切开术和第三脑室造瘘术（n=12）。在所有情况下，受训者报告说他们的术后信心评分有所提高，平均术前和术后 Likert 评分分别为 2.85±1.09 和 4.14±0.93（P<.05）。
通过重建血管和 CSF 途径来增强新鲜尸体标本是补充多种神经外科手术训练的可行方法，并且可能对神经外科住院医师教育的未来产生影响。
