The learning curve for endoscopic endonasal pituitary surgery: a systematic review

Endoscopic Occipital Transtentorial Approach for Dorsal Midbrain Cavernous Malformation: Technical Notes With Illustrative Case

BACKGROUND

The dorsal midbrain, an anatomically intricate region, presents significant challenges for traditional surgical interventions due to the heightened risk of vascular and neurological injury, and the necessity of brain tissue retraction.

METHODS

This study retrospectively reviewed the case of a 29-year-old male diagnosed with a cavernous malformation located in the dorsal aspect of the left midbrain. The patient underwent resection via the endoscopic occipital transtentorial approach (EOTA) in July 2024. Comprehensive records were analyzed, including preoperative magnetic resonance imaging and computed tomography imaging, detailed surgical notes, and postoperative outcomes.

RESULTS

The patient initially presented with headaches and diplopia. Imaging revealed a 17 × 13 mm tumor in the dorsal aspect of the left midbrain, associated with obstructive hydrocephalus. The 2.5-hour EOTA surgery resulted in complete resection of the tumor, with the resolution of headache symptoms and improvement of diplopia. No new complications were reported postoperatively. The patient was discharged 7 days postsurgery without the need for intensive care unit admission. Pathological examination confirmed the diagnosis of a cavernous malformation. Additionally, the EOTA facilitated a concurrent endoscopic third ventriculostomy, and no evidence of hydrocephalus was observed during the 3-month follow-up period.

CONCLUSIONS

The EOTA constitutes a significant advancement in neurosurgical techniques for the resection of dorsal midbrain tumors, enhancing surgical precision and safety. This approach contributes to improved patient outcomes and a reduction in complication rates. Further studies are warranted to validate these findings and to establish standardized protocols for the application of EOTA in midbrain tumor resection.

Spatial Cognition Ability in Surgeons Performing Endoscopic Endonasal Transsphenoidal Surgery

Endoscopic surgery, including endoscopic endonasal transsphenoidal surgery (ETSS), requires special psychomotor skills from surgeons. The learning curve in the acquisition of psychomotor skills varies among individuals, and studies about laparoscopy indicate that the difference can be predicted using spatial ability tests. We examined the association between the results of such tests and the learning curve in ETSS to determine the need for a personalized curriculum for ETSS skill training. A total of 30 fifth-year medical students from Kindai University School of Medicine (17 men, 13 women; mean age, 26 years) without ETSS experience completed the spatial orientation test (SOT) for the measurement of spatial visualization ability. They performed the dural incision task (DIT) twice on an ETSS training model for surgical psychomotor skill evaluation. The SOT scores (angle errors) exhibited substantial individual differences in spatial visualization ability, whereas the DIT scores significantly improved in the second trial (Wilcoxon signed-rank test, P = 0.0035). However, no significant difference was observed in the DIT scores between the smaller error and larger error groups of the SOT. The results indicated that two DIT trials were sufficient to acquire psychomotor skills for the DIT as the endoscope was almost fixed and learning only one viewpoint and line of sight combination was adequate. In conclusion, a personalized ETSS training program based on the trainee's spatial ability is not necessary for the DIT. Further research is warranted to determine the effect of spatial ability on more complex tasks, such as suturing in cranial base repair.

Neuroimaging of Brain Tumor Surgery and Epilepsy

To make the best clinical judgements, surgeons need to integrate information acquired via multimodal imaging [...].