Search

Objective Surgical clipping has become a relatively rare procedure in comparison to endovascular exclusion of cerebral aneurysms. Consequently, there is a declining number of cases where young neurosurgeons can practice clipping. For this reason, we investigated the application of a new 3-dimensional (3D) simulation and rehearsal device, Surgical Theater, in vascular neurosurgery. Methods We analyzed data of 20 patients who underwent surgical aneurysm clipping. In 10 cases, Surgical Theater was used to perform the preoperative 3D planning (CASCADE group), while traditional imaging was used in the other cases (control group). Preoperative 3D simulation was performed by 4 expert and 3 junior neurosurgeons (1 fellow, 2 residents). During postoperative debriefings, expert surgeons explained the different aspects of the operation to their younger colleagues in an interactive way using the simulator. Questionnaires were given to the surgeons to get qualitative feedback about the simulator, and the junior surgeons' performance at simulator was also analyzed. Results There were no differences in surgery outcomes, complications, and surgical duration (P > 0.05) between the 2 groups. Senior neurosurgeons performed similarly when operating at the simulator as compared with in the operating room, while junior neurosurgeons improved their performance at the simulator after the debriefing session (P Conclusions Surgical Theater proved to be realistic in replicating vascular neurosurgery scenarios for rehearsal and simulation purposes. Moreover, it was shown to be useful for didactic purposes, allowing young neurosurgeons to take full advantage and learn from senior colleagues to become familiar with this demanding neurosurgical subspecialty.

Neurosurgical 3D visualizers and simulators are innovative devices capable of defining a surgical strategy in advance and possibly making neurosurgery safer by rehearsing the phases of the operation beforehand. The aim of this study is to evaluate Surgical Theater™, a new 3D neurosurgical planning, simulation, and navigation system, and qualitatively assess its use in the operating room.Clinical data were collected from 30 patients harbouring various types of brain tumours; Surgical Theater™ was used for the preoperative planning and intraoperative 3D navigation. Preoperative and postoperative questionnaires were completed by first and second operators to get qualitative feedback on the system's functionality. Furthermore, we measured and compared the impact of this technology on surgery duration.Neurosurgeons were overall satisfied when using this rehearsal and navigation tool and found it efficient and easy to use; interestingly, residents considered this device more useful as compared to their more senior colleagues (with significantly higher scores, p0.05), possibly because of their limited anatomical experience and spatial/surgical rehearsal ability. The length of the surgical procedure was not affected by this technology (p0.05).Surgical Theater™ system was found to be clinically useful in improving anatomical understanding, surgical planning and intraoperative navigation, especially for younger and less experienced neurosurgeons.

Background Skull base meningiomas represent a challenge for neurosurgeons, and the procedures are typically performed by experienced neurosurgeons, thus limiting resident training. A new simulation and rehearsal device can be used as an aid for senior surgeons during these operations and serve as a training tool for junior surgeons. Methods Forty patients harboring an anterior/middle fossa meningioma were recruited. Surgical Theater, a rehearsal/simulation platform, was used for preoperative planning and intraoperative 3D navigation on 20 patients (CT-MADE group), while the remaining (control group) underwent a traditional navigation. Qualitative comparisons between the 2 groups were made with regard to surgical procedure and patient outcome. Satisfaction questionnaires were completed by expert neurosurgeons and residents to assess the overall usefulness of the platform. Furthermore, the surface of the simulated craniotomy performed during the planning was compared with the one actually performed during surgery in order to evaluate the reliability of the planning. Results No differences between the 2 groups were found (surgery duration: P = 0.4; visual impairment: P = 0.56). Both residents and senior neurosurgeons enjoyed using the platform for intraoperative navigation and planning; simulated craniotomies were significantly smaller as compared with the real ones (P = 0.009), probably because it was not intuitive to depict the exact margins of the operculum with the platform. Conclusion Surgical Theater helped residents to improve their anatomic and procedural comprehension and was deemed as a useful aid to safely perform some demanding neurosurgical procedures, by both senior and junior surgeons.

The informed consent is a defining moment that should allow patients to understand their condition, what procedure they are undergoing, and what consequences may follow. This process should foster trust and promote confidence, without increasing patients’ anxiety. New immersive 3D imaging technologies may serve as a tool to facilitate this endeavor. In a prospective, single-center, randomized controlled clinical trial (SPLICE Study: Surgical Planning and Informed Consent Study; ClinicalTrials.gov NCT03503487), 40 patients undergoing surgery for intracranial tumors were enrolled. After undergoing a traditional surgical informed consent acquisition, 33 patients were randomized 1:1:1 to 3 groups: in 2 experimental groups, patients underwent a 3D, immersive informed consent with two different surgical planners (group 1 and group 2); in the control group, patients underwent an informed consent supported by traditional 2D radiological images. Patients in the experimental groups appreciated this communication experience, while their objective comprehension was higher ((score mean (SD)): group 1 82.65 (6.83); group 2 77.76 (10.19)), as compared with the control group (57.70 (12.49); P

Neurosurgical training has traditionally been based on an apprenticeship model that requires considerable time and exposure to surgeries. Unfortunately, nowadays these requirements are hampered by several limitations (e.g., decreased caseload, worktime restrictions). Furthermore, teaching methods vary among residency programs due to cultural differences, monetary restrictions, and infrastructure conditions, with the possible consequence of jeopardizing residents’ training. The EANS Basic Brain Course originated from a collaboration between the Besta NeuroSim Center in Milano and the Swiss Foundation for Innovation and Training in Surgery in Geneva. It was held for 5 neurosurgical residents (PGY1-3) who participated to this first pilot experience in January 2019. The main goal was to cover the very basic aspects of cranial surgery, including both technical and non-technical skills. The course was developed in modules, starting from the diagnostic paths and communication with patients (played by professional actors), then moving to practical simulation sessions, rapid theoretical lessons, and discussions based on real cases and critical ethical aspects. At the end, the candidates had cadaver lab sessions in which they practiced basic emergency procedures and craniotomies. The interaction between the participants and the faculties was created and maintained using role plays that smoothly improved the cooperation during debriefs and discussions, thus making the sessions exceedingly involving. At the end of the course, every trainee was able to complete the course curriculum and all the participants expressed their appreciation for this innovative format, with a particular emphasis on the time spent learning non-technical skills, confirming that they feel this to be a fundamental aspect of a comprehensive training in neurosurgery. It is possible that this combined concept of training on technical and non-technical skills, using emerging technologies along with pedagogic techniques and cadaver dissection, may become the state-of-the-art for European Neurosurgical training programs in the next future.

Background Intraoperative ultrasound (iUS) is an excellent aid for neurosurgeons to perform better and safer operations thanks to real time, continuous, and high-quality intraoperative visualization. Objective To develop an innovative training method to teach how to perform iUS in neurosurgery. Methods Patients undergoing surgery for different brain or spine lesions were iUS scanned (before opening the dura) in order to arrange a collection of 3-dimensional, US images; this set of data was matched and paired to preoperatively acquired magnetic resonance images in order to create a library of neurosurgical cases to be studied offline for training and rehearsal purposes. This new iUS training approach was preliminarily tested on 14 European neurosurgery residents, who participated at the 2016 European Association of Neurosurgical Societies Training Course (Sofia, Bulgaria). Results USim was developed by Camelot and the Besta NeuroSim Center as a dedicated app that transforms any smartphone into a "virtual US probe," in order to simulate iUS applied to neurosurgery on a series of anonymized, patient-specific cases of different central nervous system tumors (eg, gliomas, metastases, meningiomas) for education, simulation, and rehearsal purposes. USim proved to be easy to use and allowed residents to quickly learn to handle a US probe and interpret iUS semiotics. Conclusion USim could help neurosurgeons learn neurosurgical iUS safely. Furthermore, neurosurgeons could simulate many cases, of different brain/spinal cord tumors, that resemble the specific cases they have to operate on. Finally, the library of cases would be continuously updated, upgraded, and made available to neurosurgeons.