Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA.
Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA.
World Neurosurg. 2021 Feb;146:e86-e90. doi: 10.1016/j.wneu.2020.10.026. Epub 2020 Oct 12.
The landscape of microneurosurgery has changed considerably over the past 2 decades, with a decline in indications for open surgery on cerebrovascular pathology and ever-increasing indications for open resection of brain tumors. This study investigated how these trends in case volume affected residents' training experiences in microsurgery and, specifically, Sylvian fissure dissection.
Resident case logs were reviewed, identifying open cerebrovascular operations and craniotomies for tumor. Operations involving Sylvian fissure dissection were identified through operative reports. Changes in case number by resident were plotted over time, and linear regression was applied.
Among 23 chief residents, 3045 operations were identified, 1071 of which were for cerebrovascular pathology and 1974 for tumor. Open cerebrovascular experience decreased (P < 0.0001) while tumor volume remained unchanged (P = 0.221). The number of Sylvian fissure dissections per resident did not change over time overall (P = 0.583) or within cerebrovascular operations (P = 0.071). The number of Sylvian fissure dissections in tumor operations increased (P = 0.004). This effect was predominated by an increase in intraaxial tumors approached via Sylvian fissure dissection (P = 0.003). The proportion of Sylvian fissure dissections in tumor surgery increased from 15% in 2009 to 34% by 2019 (P = 0.003).
Residents are seeing an increasing proportion of their Sylvian fissure dissection experience during tumor operations. The distribution of this experience will continue to evolve as surgical indications change but suggests a growing role for tumor surgeons in resident training in microsurgery.
在过去的 20 年中，神经显微外科学领域发生了重大变化，开颅手术治疗脑血管病的适应证减少，而开颅切除脑肿瘤的适应证不断增加。本研究旨在探讨这些病例数量的变化趋势如何影响住院医师在显微外科方面的培训经验，特别是在侧裂区解剖方面。
回顾住院医师的手术记录，确定开颅脑血管手术和肿瘤手术。通过手术报告确定涉及侧裂区解剖的手术。通过时间绘制住院医师的病例数量变化图，并应用线性回归。
在 23 名住院医师中，共确定了 3045 例手术，其中 1071 例为脑血管病，1974 例为肿瘤。开颅脑血管手术经验减少（P<0.0001），而肿瘤体积保持不变（P=0.221）。总体而言，每位住院医师的侧裂区解剖数量并未随时间变化（P=0.583），也未随脑血管手术变化（P=0.071）。肿瘤手术中的侧裂区解剖数量增加（P=0.004）。这种变化主要是由于经侧裂入路切除的脑内肿瘤数量增加（P=0.003）。2009 年肿瘤手术中侧裂区解剖的比例为 15%，到 2019 年增加到 34%（P=0.003）。
住院医师在肿瘤手术中越来越多地获得侧裂区解剖经验。随着手术适应证的变化，这种经验的分布将继续演变，但这表明肿瘤外科医生在住院医师显微外科培训中的作用越来越大。
