Thiong'o Grace M, Looi Thomas, Rutka James T, Kulkarni Abhaya V, Drake James M
1The Hospital for Sick Children, Posluns Center for Image Guided Innovation and Therapeutic Intervention; and.
2Department of Surgery, University of Toronto, Ontario, Canada.
J Neurosurg. 2022 Jun 17;138(1):1-8. doi: 10.3171/2022.5.JNS22545. Print 2023 Jan 1.
Early adaptors of surgical simulation have documented a translation to improved intraoperative surgical performance. Similar progress would boost neurosurgical education, especially in highly nuanced epilepsy surgeries. This study introduces a hands-on cerebral hemispheric surgery simulator and evaluates its usefulness in teaching epilepsy surgeries.
Initially, the anatomical realism of the simulator and its perceived effectiveness as a training tool were evaluated by two epilepsy neurosurgeons. The surgeons independently simulated hemispherotomy procedures and provided questionnaire feedback. Both surgeons agreed on the anatomical realism and effectiveness of this training tool. Next, construct validity was evaluated by modeling the proficiency (task-completion time) of 13 participants, who spanned the experience range from novice to expert.
Poisson regression yielded a significant whole-model fit (χ2 = 30.11, p < 0.0001). The association between proficiency when using the training tool and the combined effect of prior exposure to hemispherotomy surgery and career span was statistically significant (χ2 = 7.30, p = 0.007); in isolation, pre-simulation exposure to hemispherotomy surgery (χ2 = 6.71, p = 0.009) and career length (χ2 = 14.21, p < 0.001) were also significant. The mean (± SD) task-completion time was 25.59 ± 9.75 minutes. Plotting career length against task-completion time provided insights on learning curves of epilepsy surgery. Prediction formulae estimated that 10 real-life hemispherotomy cases would be needed to approach the proficiency seen in experts.
The cerebral hemispheric surgery simulator is a reasonable epilepsy surgery training tool in the quest to increase preoperative practice opportunities for neurosurgical education.
手术模拟的早期采用者已证明其能转化为术中手术表现的改善。类似的进展将推动神经外科教育，尤其是在高度精细的癫痫手术方面。本研究引入了一种实践操作的大脑半球手术模拟器，并评估其在癫痫手术教学中的实用性。
最初，由两位癫痫神经外科医生评估模拟器的解剖逼真度及其作为培训工具的感知有效性。外科医生独立模拟大脑半球切除术过程并提供问卷反馈。两位外科医生均认可该培训工具的解剖逼真度和有效性。接下来，通过对13名参与者（经验范围从新手到专家）的熟练程度（任务完成时间）进行建模来评估结构效度。
泊松回归得出显著的全模型拟合（χ2 = 30.11，p < 0.0001）。使用培训工具时的熟练程度与先前接触大脑半球切除术手术和职业生涯跨度的综合效应之间的关联具有统计学意义（χ2 = 7.30，p = 0.007）；单独来看，模拟前接触大脑半球切除术手术（χ2 = 6.71，p = 0.009）和职业生涯长度（χ2 = 14.21，p < 0.001）也具有统计学意义。平均（±标准差）任务完成时间为25.59 ± 9.75分钟。绘制职业生涯长度与任务完成时间的关系图，为癫痫手术的学习曲线提供了见解。预测公式估计，需要10例实际的大脑半球切除术病例才能达到专家所表现出的熟练程度。
大脑半球手术模拟器是一种合理的癫痫手术培训工具，有助于增加神经外科教育的术前实践机会。
