Impact of Resident Participation During Surgery on Neurosurgical Outcomes: A Meta-Analysis

Simulated spinal durotomy repair for orthopaedic resident training: a perfusion-based porcine cadaveric specimen as an in vitro animal model

BACKGROUND

Training in delicate spinal dura mater suturing techniques poses significant challenges due to patient safety and medicolegal concerns, driving the need for alternative training methods beyond traditional mentorship models. This study aimed to introduce and validate a training model for orthopaedic residents using perfusion-based porcine spines to simulate intraoperative durotomy and subsequent repair.

METHODS

Nine junior orthopaedic residents were invited to participate. Three attending orthopaedic spine surgeons were included in the control group. Fresh porcine spines were used for the simulation, and a perfusion-based system was implemented to replicate cerebrospinal fluid circulation and apply hydrostatic pressure to the dura. Durotomies were made and mended with 6-0 prolene sutures, and the participants' performance was assessed across six trials for repair speed and leakage pressure. Additionally, the self-confidence levels of the residents were analyzed before and after the training.

RESULTS

While attending surgeons showed consistent performance across trials, residents demonstrated a 70% reduction in mean total time and a 62% increase in mean leakage pressure after training. Residents showed significant improvements in repair speed from Trial 4 and in repair quality from Trial 3 compared with Trial 1 as the baseline. The difference compared with attending surgeons became insignificant in repair speed from Trial 4 and in repair quality from Trial 2, indicating that the residents' performance approached that of the attending surgeons. Residents' self-confidence increased significantly from a mean pre-training score of 1.1 to a mean post-training score of 4.3.

CONCLUSIONS

This simulation model, which utilizes fresh porcine spines and a perfusion-based system, is an accessible, cost-effective, and high-fidelity training method for dural repair during spinal surgery.

Complications From Subdural Drains in Burr Hole Drainage of Chronic and Subacute Subdural Haematomas: A Single-Centre Experience

Introduction The use of drains following the burr-hole evacuation of chronic (CSDH) and subacute subdural haematomas (SASDH) is a well-established practice offering a significant reduction in recurrence rates and improvement of survival. The purpose of this work is to investigate the complication rate of subdural drains following the burr-hole evacuation of CSDH and SASDH. Methods A retrospective review of the clinical records of all patients managed surgically for CSDH or SASDH was conducted. Patients over 18 years, that met the criteria for surgical evacuation, were included in this study. Patients admitted for CSDH or SASDH but managed either conservatively or with craniotomy were excluded from further analysis. Results A total of 97 cases, with a mean age at the time of diagnosis of 78.25 years were identified in which 122 drains were used. Three complications, two acute subdural haematomas, and one case of drain-associated seizures were identified, yielding an overall complication rate of 3%. Conclusion The use of intradural drains is associated with a small, yet not negligible, possibility of serious complications.