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Shakir M, Irshad HA, Altaf A, Ladak S, Aziz HF, Enam SA. Does gender disparity exist in neurosurgery training? Evidence from a nationwide survey from Pakistan. Med Educ Online 2024; 29:2310385. [PMID: 38290059 PMCID: PMC10829840 DOI: 10.1080/10872981.2024.2310385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/22/2024] [Indexed: 02/01/2024]
Abstract
Gender disparities are prevalent in the neurosurgical field, particularly for female trainees, despite the growing demand for neurosurgeons. The situation is bleaker in low-and middle-income countries, where gender disparities among neurosurgical trainees have not been evaluated. We aimed to gauge the gender differences in opportunities and perceptions of neurosurgery training in Pakistan by comparing responses between males and females. A nationwide web-based survey was conducted in Pakistan, covering 22 College of Physicians and Surgeons of Pakistan (CPSP) accredited neurosurgery training programs. Convenience sampling was used with a pilot-tested questionnaire. Data analysis was performed using SPSS version 26. A total of 120 trainees participated in our survey. The mean age of the participants was 30.4 ± 4.1 years, with 29.2% females and 70.8% males. Concerns about gender equity were more among females (34.3%) than males (27.1%). Poor work-life balance was reported by more females (34.3%) than males (30.6%). Burnout due to working hours was strongly agreed by more females (54.3%) than males (35.3%). More females (40%) acknowledged sufficient mentorship opportunities versus males (25%). Female respondents (65.7%) worked 50-100 hours per week, less than males (69.4%). Satisfaction with surgical exposure was lower among females (2.9%) compared to males (18.8%). More females reported access to teaching courses (82.9% vs. 77.6% males) and neurosurgical conferences (85.7% vs. 80.0% males), cadaver workshops (17.1% vs. 12.9% males), morbidity and mortality meetings (88.6% vs. 82.4% males), case-based sessions (82.9% vs. 75.3% males), and radiology discussions (82.9% vs. 74.1% males). Our study highlights substantial gender gaps in neurosurgical training, concerns over working hours, burnout, mentorship, work-life balance, and gender equity. These findings underscore the necessity for interventions to rectify these disparities and foster gender equity in neurosurgical training.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Hammad Atif Irshad
- Medical Student, Medical College, Aga Khan University, Karachi, Pakistan
| | - Ahmed Altaf
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Shamila Ladak
- Medical Student, Medical College, Aga Khan University, Karachi, Pakistan
| | - Hafiza Fatima Aziz
- Neuro-oncology Fellow, Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Begagić E, Bečulić H, Pugonja R, Memić Z, Balogun S, Džidić-Krivić A, Milanović E, Salković N, Nuhović A, Skomorac R, Sefo H, Pojskić M. Augmented Reality Integration in Skull Base Neurosurgery: A Systematic Review. Medicina (Kaunas) 2024; 60:335. [PMID: 38399622 PMCID: PMC10889940 DOI: 10.3390/medicina60020335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: To investigate the role of augmented reality (AR) in skull base (SB) neurosurgery. Materials and Methods: Utilizing PRISMA methodology, PubMed and Scopus databases were explored to extract data related to AR integration in SB surgery. Results: The majority of 19 included studies (42.1%) were conducted in the United States, with a focus on the last five years (77.8%). Categorization included phantom skull models (31.2%, n = 6), human cadavers (15.8%, n = 3), or human patients (52.6%, n = 10). Microscopic surgery was the predominant modality in 10 studies (52.6%). Of the 19 studies, surgical modality was specified in 18, with microscopic surgery being predominant (52.6%). Most studies used only CT as the data source (n = 9; 47.4%), and optical tracking was the prevalent tracking modality (n = 9; 47.3%). The Target Registration Error (TRE) spanned from 0.55 to 10.62 mm. Conclusion: Despite variations in Target Registration Error (TRE) values, the studies highlighted successful outcomes and minimal complications. Challenges, such as device practicality and data security, were acknowledged, but the application of low-cost AR devices suggests broader feasibility.
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Affiliation(s)
- Emir Begagić
- Department of General Medicine, School of Medicine, University of Zenica, Travnička 1, 72000 Zenica, Bosnia and Herzegovina;
| | - Hakija Bečulić
- Department of Neurosurgery, Cantonal Hospital Zenica, Crkvice 67, 72000 Zenica, Bosnia and Herzegovina; (H.B.)
- Department of Anatomy, School of Medicine, University of Zenica, Travnička 1, 72000 Zenica, Bosnia and Herzegovina;
| | - Ragib Pugonja
- Department of Anatomy, School of Medicine, University of Zenica, Travnička 1, 72000 Zenica, Bosnia and Herzegovina;
| | - Zlatan Memić
- Department of General Medicine, School of Medicine, University of Zenica, Travnička 1, 72000 Zenica, Bosnia and Herzegovina;
| | - Simon Balogun
- Division of Neurosurgery, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ilesa Road PMB 5538, Ile-Ife 220282, Nigeria
| | - Amina Džidić-Krivić
- Department of Neurology, Cantonal Hospital Zenica, Crkvice 67, 72000 Zenica, Bosnia and Herzegovina
| | - Elma Milanović
- Neurology Clinic, Clinical Center University of Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina
| | - Naida Salković
- Department of General Medicine, School of Medicine, University of Tuzla, Univerzitetska 1, 75000 Tuzla, Bosnia and Herzegovina;
| | - Adem Nuhović
- Department of General Medicine, School of Medicine, University of Sarajevo, Univerzitetska 1, 71000 Sarajevo, Bosnia and Herzegovina;
| | - Rasim Skomorac
- Department of Neurosurgery, Cantonal Hospital Zenica, Crkvice 67, 72000 Zenica, Bosnia and Herzegovina; (H.B.)
- Department of Surgery, School of Medicine, University of Zenica, Travnička 1, 72000 Zenica, Bosnia and Herzegovina
| | - Haso Sefo
- Neurosurgery Clinic, Clinical Center University of Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina
| | - Mirza Pojskić
- Department of Neurosurgery, University Hospital Marburg, Baldingerstr., 35033 Marburg, Germany
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Hey G, Guyot M, Carter A, Lucke-Wold B. Augmented Reality in Neurosurgery: A New Paradigm for Training. Medicina (Kaunas) 2023; 59:1721. [PMID: 37893439 PMCID: PMC10608758 DOI: 10.3390/medicina59101721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/29/2023]
Abstract
Augmented reality (AR) involves the overlay of computer-generated images onto the user's real-world visual field to modify or enhance the user's visual experience. With respect to neurosurgery, AR integrates preoperative and intraoperative imaging data to create an enriched surgical experience that has been shown to improve surgical planning, refine neuronavigation, and reduce operation time. In addition, AR has the potential to serve as a valuable training tool for neurosurgeons in a way that minimizes patient risk while facilitating comprehensive training opportunities. The increased use of AR in neurosurgery over the past decade has led to innovative research endeavors aiming to develop novel, more efficient AR systems while also improving and refining present ones. In this review, we provide a concise overview of AR, detail current and emerging uses of AR in neurosurgery and neurosurgical training, discuss the limitations of AR, and provide future research directions. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 386 articles were initially identified. Two independent reviewers (GH and AC) assessed article eligibility for inclusion, and 31 articles are included in this review. The literature search included original (retrospective and prospective) articles and case reports published in English between 2013 and 2023. AR assistance has shown promise within neuro-oncology, spinal neurosurgery, neurovascular surgery, skull-base surgery, and pediatric neurosurgery. Intraoperative use of AR was found to primarily assist with surgical planning and neuronavigation. Similarly, AR assistance for neurosurgical training focused primarily on surgical planning and neuronavigation. However, studies included in this review utilize small sample sizes and remain largely in the preliminary phase. Thus, future research must be conducted to further refine AR systems before widespread intraoperative and educational use.
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Affiliation(s)
- Grace Hey
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Michael Guyot
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Ashley Carter
- Eastern Virginia Medical School, Norfolk, VA 23507, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
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Carrizales-Rodriguez J, Borrayo-Dorado S, Méndez-Guerrero I, Sanchez J, Rios-Ramirez F, Cardenas-Garcia Y, Abdala-Vargas N, Höllig A, Méndez-Rosito D. The Hibiscus model: A feasible cadaveric model using continuous arterial circulation for intracranial bypass training and its validation. World Neurosurg 2023:S1878-8750(23)00201-2. [PMID: 36796625 DOI: 10.1016/j.wneu.2023.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE The frequency of intracranial bypass procedures has declined. Thus, it is difficult for neurosurgeons to develop the necessary skills for this complex procedure. We present a perfusion-based cadaveric model to provide a realistic training experience with high anatomical and physiological fidelity as well as instantaneous assessment of bypass patency. Validation was assessed by evaluating the educational impact and skill improvement of the participants. METHODS Fourteen participants attended a hands-on revascularization course with seven cadaveric models connected to a continuous arterial circulation system pumping a red-colored solution through the entire cranial vasculature, mimicking blood circulation. The ability to perform a vascular anastomosis was evaluated initially. Further, a questionnaire on prior experience was provided. At the end of the 36-hour course, the ability to perform an intracranial bypass was re-examined and the participants completed a self-assessment questionnaire. RESULTS Initially, only three attendees were able to perform an end-to-end anastomosis within the time limit, and only two of these anastomoses showed adequate patency. After having accomplished the course, all participants were able to complete a patent end-to-end anastomosis within the time limit, thus, demonstrating a significant improvement. Further, both overall educational gain and surgical skills were regarded as remarkable (n=11 and n=9) CONCLUSIONS: Simulation-based education is considered an important aspect of medical and surgical development. The presented model is a feasible and accessible alternative to the prior models used for cerebral bypass training. This training may serve as a helpful and widely available tool to improve neurosurgeons´ development irrespective of financial resources.
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Affiliation(s)
- Juan Carrizales-Rodriguez
- Department of Skull Base and Endoscopic Neurosurgery, Centro Médico Nacional "20 de Noviembre". 540 Félix Cuevas St 03104, México City ,México
| | - Sheila Borrayo-Dorado
- Department of Skull Base and Endoscopic Neurosurgery, Centro Médico Nacional "20 de Noviembre". 540 Félix Cuevas St 03104, México City ,México
| | - Ivan Méndez-Guerrero
- Department of Skull Base and Endoscopic Neurosurgery, Centro Médico Nacional "20 de Noviembre". 540 Félix Cuevas St 03104, México City ,México
| | - Javier Sanchez
- Department of Skull Base and Endoscopic Neurosurgery, Centro Médico Nacional "20 de Noviembre". 540 Félix Cuevas St 03104, México City ,México
| | - Francisco Rios-Ramirez
- Instituto Politecnico Nacional Superior School of Medicine, W/N Plan de San Luis St Mexico City, 11340, Mexico
| | - Yolanda Cardenas-Garcia
- Instituto Politecnico Nacional Superior School of Medicine, W/N Plan de San Luis St Mexico City, 11340, Mexico
| | - Nadin Abdala-Vargas
- Department of Neurological Surgery Fundación Universitaria de Ciencias de la Salud, Hospital San Jose 18-75 Calle 10 St, Bogota, Colombia
| | - Anke Höllig
- Department of Neurosurgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Diego Méndez-Rosito
- Department of Skull Base and Endoscopic Neurosurgery, Centro Médico Nacional "20 de Noviembre". 540 Félix Cuevas St 03104, México City ,México.
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D’Andrea M, Musio A, Colasanti R, Mongardi L, Fuschillo D, Lofrese G, Tosatto L. A novel, reusable, realistic neurosurgical training simulator for cerebrovascular bypass surgery: Iatrotek ® bypass simulator validation study and literature review. Front Surg 2023; 10:1048083. [PMID: 36843992 PMCID: PMC9947354 DOI: 10.3389/fsurg.2023.1048083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
Background Microanastomosis is a challenging technique requiring continuous training to be mastered. Several models have been proposed, but few effectively reflect a real bypass surgery; even fewer are reusable, most are not easily accessible, and the setting is often quite long. We aim to validate a simplified, ready-to-use, reusable, ergonomic bypass simulator. Methods Twelve novice and two expert neurosurgeons completed eight End-to-End (EE), eight End-to-Side (ES), and eight Side-to-Side (SS) microanastomoses using 2-mm synthetic vessels. Data on time to perform bypass (TPB), number of sutures and time required to stop potential leaks were collected. After the last training, participants completed a Likert Like Survey for bypass simulator evaluation. Each participant was assessed using the Northwestern Objective Microanastomosis Assessment Tool (NOMAT). Results When comparing the first and last attempts, an improvement of the mean TPB was registered in both groups for the three types of microanastomosis. The improvement was always statistically significant in the novice group, while in the expert group, it was only significant for ES bypass. The NOMAT score improved in both groups, displaying statistical significance in the novices for EE bypass. The mean number of leakages, and the relative time for their resolution, also tended to progressively reduce in both groups by increasing the attempts. The Likert score expressed by the experts was slightly higher (25 vs. 24.58 by the novices). Conclusions Our proposed bypass training model may represent a simplified, ready-to-use, reusable, ergonomic, and efficient system to improve eye-hand coordination and dexterity in performing microanastomoses.
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Affiliation(s)
- Marcello D’Andrea
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
| | - Antonio Musio
- Department of Ferrara – Neurosurgery, Sant ‘Anna University Hospital, Ferrara, Italy,Correspondence: Antonio Musio
| | | | - Lorenzo Mongardi
- Department of Ferrara – Neurosurgery, Sant ‘Anna University Hospital, Ferrara, Italy
| | - Dalila Fuschillo
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
| | - Giorgio Lofrese
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
| | - Luigino Tosatto
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
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6
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Lizana J, Montemurro N, Aliaga N, Marani W, Tanikawa R. From textbook to patient: a practical guide to train the end-to-side microvascular anastomosis. Br J Neurosurg 2023; 37:116-120. [PMID: 34092156 DOI: 10.1080/02688697.2021.1935732] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Microvascular anastomosis is one of the most challenging neurosurgical techniques. Mastering this technique allows to perform intracranial bypass with arteries of small caliber usually placed in deep narrow surgical fields. The aim of this paper is to describe step by step end-to-side microanastomosis training method by using polyvinyl alcohol (PVA) hydrogel tubing as it is easily reproducible. The tubing comes in sizes from 0.3 mm to 5 mm and has a texture and consistency similar to real vessels. This is based on the Teishinkai Hospital anastomosis technique. Continuous practice in microvascular anastomosis is of great importance in training vascular neurosurgeon. The PVA hydrogel tubing described in this article are useful and cost-effective material in the training of microvascular anastomosis. This practical guide model is easy to set up for repeated practice, and will contribute to facilitate 'off-the-job' training by young neurosurgeons and the development and maintenance of microsurgical skills in both resident neurosurgeons and experts who wish to master the various levels of anastomosis technique. There is no shortcut to master this technique, only hard work and perseverance.
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Affiliation(s)
- Jafeth Lizana
- Department of Neurosurgery, Hospital Nacional Guillermo Almenara, Lima, Perú.,Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Pisa, Italy
| | - Nelida Aliaga
- Medicine Faculty, Hospital Universidad Austral, Buenos Aires, Argentina
| | - Walter Marani
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan.,Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Pisa, Italy
| | - Rokuya Tanikawa
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
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7
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Ukachukwu AEK, Still MEH, Seas A, von Isenburg M, Fieggen G, Malomo AO, Shokunbi MT, Egger JR, Haglund MM, Fuller AT. Fulfilling the specialist neurosurgical workforce needs in Africa: a systematic review and projection toward 2030. J Neurosurg 2022; 138:1102-1113. [PMID: 35962968 DOI: 10.3171/2022.2.jns211984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/14/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Africa contributes significantly to the global neurosurgical disease burden but has only 1% of the neurosurgery workforce. This study appraises the neurosurgical workforce and training capacity in Africa and projects the workforce capacity by 2030. METHODS The authors conducted a systematic review of the online literature on neurosurgical workforce and training in Africa obtained from three journal databases (PubMed, Embase, and African Index Medicus), as well as from a gray literature search, between September and December 2020. Included literature passed a two-level screening conducted using a systematic review software by a team of two independent reviewers. Data were extracted from selected articles and documented and analyzed on spreadsheets. RESULTS One hundred and fifty-nine eligible articles were analyzed: 1974 neurosurgeons serve 1.3 billion people in Africa (density 0.15 per 100,000 persons, ratio 1:678,740), with uneven distribution between the regions. North Africa has 64.39% of the neurosurgical workforce (n = 1271), followed by Southern Africa (12.66%, n = 250), West Africa (11.60%, n = 229), East Africa (8.26%, n = 163), and Central Africa (3.09%, n = 61). At an exponential growth rate of 7.03% (95% CI 5.83%-8.23%) per annum, Africa will have 3418 (95% CI 1811-6080) neurosurgeons by 2030, with a deficit of 5191 neurosurgeons, based on population workforce targets. In terms of training, there are 106 neurosurgery training institutions in 26 African countries. North Africa has 52 training centers (49.05%), West Africa 23 (21.70%), East Africa 15 (14.15%), Southern Africa 14 (13.21%), and Central Africa 2 (1.89%). The major regional training programs are those of the West African College of Surgeons (24 sites in 7 countries) and the College of Surgeons of East, Central, and Southern Africa (17 sites in 8 countries). CONCLUSIONS The study is limited as it is based on the online literature, some of which includes modeled estimates with questionable reliability. However, the results indicate that while countries in North Africa are expected to surpass their population workforce requirements, sub-Saharan African countries are likely to have significant workforce deficits accentuated by the paucity of neurosurgery training programs. To meet the 2030 population workforce requirements, the continent's exponential growth rate should be scaled up to 15.87% per annum. Scaling up neurosurgical training would help to meet this target and requires collaborative efforts from continental, regional, and national agencies and international organizations.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- 1Duke Global Neurosurgery and Neurology, Duke University, Durham.,2Department of Neurosurgery, Duke University Health System, Durham, North Carolina.,3Neurosurgery Unit, Asokoro District Hospital, Abuja FCT, Nigeria
| | - Megan E H Still
- 4Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Andreas Seas
- 1Duke Global Neurosurgery and Neurology, Duke University, Durham
| | - Megan von Isenburg
- 5Duke University Medical Center Library and Archives, Durham, North Carolina
| | - Graham Fieggen
- 6Division of Neurosurgery and Neuroscience Institute, University of Cape Town, South Africa
| | - Adefolarin O Malomo
- 7Department of Neurological Surgery, College of Medicine, University of Ibadan, Nigeria; and
| | - Matthew T Shokunbi
- 7Department of Neurological Surgery, College of Medicine, University of Ibadan, Nigeria; and
| | - Joseph R Egger
- 8Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Michael M Haglund
- 1Duke Global Neurosurgery and Neurology, Duke University, Durham.,2Department of Neurosurgery, Duke University Health System, Durham, North Carolina.,8Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Anthony T Fuller
- 1Duke Global Neurosurgery and Neurology, Duke University, Durham.,2Department of Neurosurgery, Duke University Health System, Durham, North Carolina.,8Duke Global Health Institute, Duke University, Durham, North Carolina
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8
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Solomou G, Venkatesh A, Patel W, Chari A, Mohan M, Bandyopadhyay S, Gillespie CS, Mendoza N, Watts C, Jenkins A. A career in neurosurgery: perceptions and the impact of a national SBNS/NANSIG neurosurgery careers day. Br J Neurosurg 2022; 36:620-626. [PMID: 35603975 DOI: 10.1080/02688697.2022.2076807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Entrance to neurosurgical training is highly competitive. Without proper advice, information and opportunities, talented individuals may be dissuaded from applying. The Neurology and Neurosurgery Interest Group (NANSIG) organises a Careers Day in Neurosurgery every year. Our objective was to assess the overall utility of a neurosurgery careers day and the perceived factors that attract and detract from the specialty, from attendees of the ninth annual neurosurgery careers day. METHODS Eighteen-item pre-conference and 19-item post-conference questionnaires were disseminated electronically to conference attendees. Questions aimed to capture: (i) baseline demographics; (ii) previous experience and exposure in neurosurgery; (iii) interest in neurosurgery; (iv) understanding training and a career in neurosurgery; (v) perceived factors of attraction and dissuasion of neurosurgery; and (vi) perceived value, quality and educational purpose of the conference. RESULTS In total, 77 delegates attended the careers day. Most did not have a formal neurosurgical rotation during medical school (24.7%, n = 19), but almost half had gained neurosurgical experience and presented research work. The careers day increased knowledge of the neurosurgical application process (median Likert score 3/5 to 4/5, p < 0.01), duration of training (72.7-88.3%), and desire to pursue a career in neurosurgery (75.3-81.8%). The most commonly reported factors attracting delegates to neurosurgery were interest in neuroanatomy (80.5%, n = 62), practical skills (64.9%, n = 50), and impact on patients (62.3%, n = 48). The most common dissuasive factors were competition to entry (64.9%, n = 50), long working hours (40.3%, n = 31), and other career interests (35.1%, n = 27). Almost all would recommend the event to a colleague (94.9%, n = 73). CONCLUSIONS Formal undergraduate exposure to neurosurgery is limited. Neurosurgery careers days increase awareness and understanding of the application process and improve interest in a selected cohort. The factors attracting applicants to neurosurgery remain practical links to neuroanatomy, opportunities in neurosurgery for innovation and research, and direct impact on patients.
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Affiliation(s)
- Georgios Solomou
- Institute of Cancer and Genome Sciences, University of Birmingham, Birmingham, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ashwin Venkatesh
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Waqqas Patel
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Aswin Chari
- Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Neurosurgery, Great Ormond Street Hospital, London, UK
| | - Midhun Mohan
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Soham Bandyopadhyay
- Oxford University Global Surgery Group, Medical Sciences Division, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Conor S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Nigel Mendoza
- West London Neurosciences Unit, Charing Cross Hospital NHS Trust, London, UK
| | - Colin Watts
- Institute of Cancer and Genome Sciences, University of Birmingham, Birmingham, UK
| | - Alistair Jenkins
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
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Borba Moreira L, Tayebi Meybodi A, Zhao X, Almefty KK, Lawton MT, Preul MC. Dissection of the Petrosal Presigmoid-Retrolabyrinthine Approach for the Petroclival Region on a Cadaver: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 19:E398-E399. [PMID: 32392291 DOI: 10.1093/ons/opaa117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/14/2020] [Indexed: 11/13/2022] Open
Abstract
Skull base epidermoid tumors, meningiomas, and schwannomas can be accessed by different techniques depending on the location and size of the lesion. Small lesions located anterior to the internal acoustic meatus (IAM) can be accessed via the subtemporal approach, and lesions located posterior to the IAM can be approached via retrosigmoid craniotomy. However, expansive lesions that are located anterior to the IAM and extend posteriorly toward the lower clivus can be accessed via the petrosal approach. The petrosal approach (presigmoid-retrolabyrinthine) is centered on the petrous ridge of the temporal bone and is mainly performed for intradural lesions located at the clivus and petroclivus junction area. Patients with intact hearing can benefit from this technique, as the labyrinth is untouched and yet the middle and posterior fossa compartments are connected. Additionally, extension of the lesion from the suprasellar area/cavernous sinus to the foramen magnum can be dissected and removed. There are variations of the petrosal approach, such as translabyrinthine, transotic, and transchoclear, with which hearing cannot be preserved, and the "transcrusal" approach, wherein posterior and superior semicircular canals are sacrificed yet hearing preserved. The endolymphatic duct is usually transected and not reapproximated. Neurotology input is always helpful when dealing with inner ear structures. This complex approach demands exhaustive practice with temporal bone dissection in a cadaver laboratory. Although this approach can be extended anteriorly, combination with an anterior petrosal approach permits more rostral exposure. In this video, we demonstrate the stepwise dissection of the posterior petrosal approach only, showing procedure nuances in a cadaver.1-8Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
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Affiliation(s)
- Leandro Borba Moreira
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Ali Tayebi Meybodi
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Xiaochun Zhao
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaith K Almefty
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael T Lawton
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C Preul
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Alimohammadi E, Eden SV, Anand SK, Ahadi P, Bostani A, Bagheri SR. The impact of coronavirus 2019 (COVID-19) on neurosurgical practice and training: a review article. Br J Neurosurg 2021; 36:569-573. [PMID: 33612023 DOI: 10.1080/02688697.2021.1888874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The 2019 coronavirus pandemic (COVID-19) has affected all of society at different levels. Similarly, COVID-19 has significantly impacted every medical field, including neurosurgery. By exposing scarcities in the healthcare industry and requiring the reallocation of available resources towards the priority setting and away from elective surgeries and outpatient visits, the pandemic posed new, unprecedented challenges to the medical community. Despite the redistribution of resources towards COVID-19 patients and away from elective surgeries, urgent and emergent surgeries for life-threatening conditions needed to be continued. The neurosurgical community, like other specialties not directly involved in the care of COVID-19 patients, initially struggled to balance the needs of COVID-19 patients with those of neurosurgical patients, residents, and researchers. Several articles describing the effect of COVID-19 on neurosurgical practice and training have been published throughout the COVID-19 pandemic. This article aims to provide a focused review of the impact COVID-19 has had on neurosurgical practice and training as well as describe neurological manifestations of the disease.
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Affiliation(s)
- Ehsan Alimohammadi
- Neurosurgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sonia V Eden
- Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Paniz Ahadi
- Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arash Bostani
- Neurology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Reza Bagheri
- Neurosurgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Mukherjee S. What does it take to become a neurosurgeon? A mixed methods cross-sectional analysis of professional identity formation amongst neurosurgical trainees. Br J Neurosurg 2021; 36:44-51. [PMID: 33586549 DOI: 10.1080/02688697.2021.1885618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The concept of professional identity (as distinct from technical skills development), and how it can be cultivated by trainees in neurosurgical training has not been explored before. AIMS This study aimed to assess neurosurgical trainees' perceptions of professional identity, how it develops and how it might be enhanced during the course of training. METHODS A mixed methods cross-sectional analysis was conducted consisting of semi-structured, in-depth interviews with a small group of neurosurgical trainees to qualitatively identify common themes around professional identity. These themes were then quantitatively analysed via a national on-line questionnaire survey amongst the wider United Kingdom neurosurgical trainee cohort. RESULTS Interviewed participants were fiveteen British neurosurgical trainees spanning across junior (n = 5), intermediate (n = 5) and senior (n = 5) levels of training at two University teaching hospitals representing high-volume tertiary centres for Neurosurgery in the United Kingdom. The on-line questionnaire survey returned complete responses by 80 trainees (30% response rate). These data demonstrated that at different stages of training, neurosurgical trainees self-identified differently, and engaged in different practices to develop their identity. However, all trainees irrespective of level appeared to perceive a common set of qualities that define the identity of a fully-fledged neurosurgeon. CONCLUSION A model has been constructed that describes professional identity formation amongst neurosurgical trainees at different stages of training, and how these feed into an aspired core identity profile of a Neurosurgeon. Based on this model, suggestions have been made to potentially improve professional identity formation amongst neurosurgical trainees.
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Affiliation(s)
- Soumya Mukherjee
- Department of Academic Neurosurgery, Leeds General Infirmary, Leeds, UK
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Singh R, Sahu A, Singh K, Prasad RS, Pandey N, Singh RC. Impact of COVID-19 Pandemic on Neurosurgical Practice in a Tertiary Care Center in India. J Neurosci Rural Pract 2021; 12:24-32. [PMID: 33531756 PMCID: PMC7846333 DOI: 10.1055/s-0040-1716455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives The aim of the study is to determine the magnitude of repercussions of coronavirus disease 2019 (COVID-19) pandemic on neurosurgical specialty and formulate a management approach. Materials and Methods This combined retrospective and prospective study was done in neurosurgical specialty of IMS-BHU, Varanasi, India, a tertiary care center, between January 1, 2020 and May 31, 2020. Analysis of impact on neurosurgical emergency and electives was done over before pandemic, during lockdown 1 and 2 and during lockdown 3 and 4 timelines. Effects of COVID-19 pandemic on psychology of neurosurgical team (50 members) and on patient party (88) were also evaluated. Virtual learning and webinars as a substitute to residential neurosurgical training were analyzed by a questionnaire given to 13 neurosurgeons of our department. Statistical Analysis Ordinary one-way ANOVA (analysis of variance) and unpaired t -test were used according to data analyzed. p < 0.05 was considered statistically significant. GraphPad Prism software was used for this analysis. Results On an average 8.22 admissions per day were done in neurosurgical emergency before pandemic. After lockdown these figures reduced to 3.2 admissions per day during lockdown 1 and 2 and to 5.36 admissions per day during lockdown 3 and 4. There was significant reduction in neurotrauma admission rate during lockdown ( p < 0.0001) at our center. There was 76% reduction in emergency neurosurgical operated cases during pandemic. There was significant reduction in outpatient department (OPD) attendance per day, OPD admissions per day ( p < 0.0001), and total elective surgeries ( p < 0.0001) during lockdown. Of 50 neurosurgical team members (neurosurgeons, nursing, and ground staff) interviewed, 90% of them had the fear of contacting the COVID-19 disease, fear of well-being of family and children, and difficulty in transport. Three out of 13 neurosurgeons (23.1%) agreed on change in practice based on what they learned from virtual teaching and webinars and only two of them (15.4%) accepted improvement of skills based on virtual learning. Conclusion The COVID-19 pandemic is causing a significant impact on health care systems worldwide. For conserving resources elective surgical procedures should be limited. This pandemic has a negative impact on neurosurgical resident training program and psychology of both neurosurgical unit and patients.
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Affiliation(s)
- Rahul Singh
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Anurag Sahu
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Kulwant Singh
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ravi Shankar Prasad
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Nityanand Pandey
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ramit Chandra Singh
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Dash C, Venkataram T, Goyal N, Chaturvedi J, Raheja A, Singla R, Sardhara J, Gupta R. Neurosurgery training in India during the COVID-19 pandemic: straight from the horse's mouth. Neurosurg Focus 2020; 49:E16. [PMID: 33260120 DOI: 10.3171/2020.9.focus20537] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has forced medical professionals throughout the world to adapt to the changing medical scenario. The objective of this survey was to assess the change in neurosurgical training in India following the COVID-19 pandemic. METHODS Between May 7, 2020, and May 16, 2020, a validated questionnaire was circulated among neurosurgical residents across India by social media, regarding changes in the department's functioning, patient interaction, surgical exposure, changes in academics, and fears and apprehensions associated with the pandemic. The responses were kept anonymous and were analyzed for changes during the COVID-19 pandemic compared to before the pandemic. RESULTS A total of 118 residents from 29 neurosurgical training programs across 17 states/union territories of the country gave their responses to the survey questionnaire. The survey revealed that the surgical exposure of neurosurgical residents has drastically reduced since the onset of the COVID-19 pandemic, from an average of 39.86 surgeries performed/assisted per month (median 30) to 12.31 per month (median 10), representing a decrease of 67.50%. The number of academic sessions has fallen from a median of 5 per week to 2 per week. The survey uncovered the lack of universal guidelines and homogeneity regarding preoperative COVID-19 testing. The survey also reveals reluctance toward detailed patient examinations since the COVID-19 outbreak. The majority of respondents felt that the COVID-19 pandemic will hamper their operative and clinical skills. Fear of rescheduling or deferring of licensing examinations was significantly higher among those closest to the examination (p = 0.002). CONCLUSIONS The adverse impact of the pandemic on neurosurgical training needs to be addressed. While ensuring the safety of the residents, institutes and neurosurgical societies/bodies must take it upon themselves to ensure that their residents continue to learn and develop neurosurgical skills during these difficult times.
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Affiliation(s)
- Chinmaya Dash
- 1Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneshwar, Orissa
| | - Tejas Venkataram
- 2Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
| | - Nishant Goyal
- 2Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
| | - Jitender Chaturvedi
- 2Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
| | - Amol Raheja
- 3Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Raghav Singla
- 4Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Jayesh Sardhara
- 5Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow; and
| | - Ravi Gupta
- 6Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Abstract
Introduction: The learning curve associated with endoscopic approaches to the spine is well established. In this study, we present our endoscopic training methodology and discuss the concepts and rationale of laboratory training as it relates to improving comfort and skill with endoscopic techniques. Materials and Methods: A three-part endoscopic training laboratory for neurosurgical trainees and attendings was organized at the University of Miami, which included a lecture, instrumentation demonstration, and both synthetic model and cadaveric practice sessions. Participants completed pre- and post-lab surveys gauging their comfort and competency in the transforaminal approach to the lumbar spine. Results: There were a total of 22 participants, with eight completing the pre-lab survey and 10 completing the post-lab survey. Sixteen participants engaged in the lab practical, with six of these participants performing the transforaminal approach on both the model and the cadaver. An increase in comfort level was demonstrated on the post-lab survey (5.9/10) for the transforaminal approach as compared to the pre-lab survey (2.6/10). Additionally, participants found the training model to be an effective teaching aid for the transforaminal technique (8.8/10). Conclusions: We believe that our study demonstrates the utility of simulated model-based training for gaining comfort and proficiency with endoscopic approaches to the spine and introduces a safe, cost-effective method of educating practitioners on novel endoscopic approaches.
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Affiliation(s)
- Gregory Basil
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - G Damian Brusko
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Jordan Brooks
- Neurological Surgery, University of Miami, Miami, USA
| | - Michael Y Wang
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
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Jean WC, Huynh T, Pham TA, Ngo HM, Syed HR, Felbaum DR. A system divided: the state of neurosurgical training in modern-day Vietnam. Neurosurg Focus 2020; 48:E2. [PMID: 32114556 DOI: 10.3171/2019.12.focus19800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/16/2019] [Indexed: 11/06/2022]
Abstract
The current report is the first of its kind in describing the neurosurgical training in modern-day Vietnam. Starting with in-depth face-to-face interviews, followed by electronically distributed questionnaires, a detailed picture of the training systems emerged.Neurosurgical training in Vietnam is multifaceted and dichotomous. The country of nearly 100 million people currently has only one neurosurgery-specific residency program, at the University of Medicine and Pharmacy at Ho Chi Minh City (UMPHCMC). This program lasts for 3 years, and Westerners might recognize many similarities to programs native to their countries. A similar training program exists in the north, at the Hanoi Medical University, but at this institution, trainees focus on neurosurgery only in the final year of their 3-year training. Neurosurgical training that resembles the program in Hanoi permeates the rest of the country, and the goal for all of the programs is to rapidly produce surgeons who can be dispersed throughout the country to treat patients requiring urgent neurosurgical procedures who are medically unsuitable for transfer to large urban centers and multispecialty hospitals. For the privilege of practicing elective neurosurgery, trainees around the country are required to acquire further training in Ho Chi Minh City or Hanoi or during fellowships abroad.A clear description of the neurosurgical training systems in Vietnam is hard to achieve, as there exist many diverse pathways and no standard definition of the endpoint for training. Unification and a clearer certification standard will likely help to elevate the standards of training and the state of neurosurgical practice in Vietnam.
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Affiliation(s)
- Walter C Jean
- 1Department of Neurosurgery, George Washington University, Washington, DC.,7Global Brainsurgery Initiative, Washington, DC
| | - Trong Huynh
- 2Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey.,3Department of Neurosurgery, Viet Duc Hospital, Hanoi, Vietnam
| | - Tuan A Pham
- 4Department of Neurosurgery, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Hung M Ngo
- 3Department of Neurosurgery, Viet Duc Hospital, Hanoi, Vietnam
| | - Hasan R Syed
- 5Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.,7Global Brainsurgery Initiative, Washington, DC
| | - Daniel R Felbaum
- 6Department of Neurosurgery, Georgetown University Hospital, Washington, DC; and.,7Global Brainsurgery Initiative, Washington, DC
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Abstract
Introduction: Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. Methods: A comprehensive literature search was performed for English language manuscripts with keywords “rural” and “neurosurgery” using the National Library of Medicine PubMed database (01/1971–06/2017). Twenty-four articles focusing on rural non-neurosurgical practice were included. Results: Time to care and/or surgery and shortage of trained personnel remain the strongest risk factors for mortality and poor outcome. Telemedicine consults to regional centers with neurosurgery housestaff have potential for increased timeliness of diagnosis/triage, improved time to surgery, and reductions in unnecessary transfers in remote areas. Mobile neurosurgery teams have been deployed with success in nations with large transport distances precluding initial transfers. Common neurosurgical procedures involve trauma mechanisms; accordingly, training programs for nonneurosurgery medical personnel on basic assessment and operative techniques have been successful in resource-deficient settings where neurosurgeons are unavailable. Conclusions: Protracted transport times, lack of resources/training, and difficulty retaining specialists are barriers to successful outcomes. Advances in telemedicine, mobile neurosurgery, and training programs for urgent operative techniques have been implemented efficaciously. Development of guidelines for paired partnerships between rural centers and academic hospitals, supplying surplus technology to rural areas, and rapid training of qualified local surgical personnel can create sustainable feed-forward programs for trainees and infrastructural solutions to address challenges in rural neurosurgery.
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Affiliation(s)
- Pavan S Upadhyayula
- Department of Neurological Surgery, University of California, San Diego, La Jolla, USA
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Jason Yang
- Department of Neurological Surgery, University of California, San Diego, La Jolla, USA
| | - Harjus S Birk
- Department of Neurological Surgery, University of California, San Diego, La Jolla, USA
| | - Joseph D Ciacci
- Department of Neurological Surgery, University of California, San Diego, La Jolla, USA
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Nguyen AV, Coggins WS, Jain RR, Branch DW, Allison RZ, Maynard K, Lall RR. Effect of an additional neurosurgical resident on procedure length, operating room time, estimated blood loss, and post-operative length-of-stay. Br J Neurosurg 2019; 34:611-615. [PMID: 31328574 DOI: 10.1080/02688697.2019.1642446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Neurosurgical residency training is costly, with expenses largely borne by the academic institutions that train residents. One expense is increased operative duration, which leads to poorer patient outcomes. Although other studies have assessed the effect of one resident assisting, none have investigated two residents; thus, we sought to investigate if two residents versus one scrubbed-in impacted operative time, estimated blood loss (EBL), and length-of-stay (LOS).Methods: In this retrospective review of patients who underwent a neurosurgical procedure involving one or two residents between January 2013 and April 2016, we performed multivariable linear regression to determine if there was an association between resident participation and case length, operating room time, EBL, and LOS. We also included patient demographics, attending surgeon, day of the week, start time, pre-operative LOS, procedure performed, and other variables in our model. Only procedures performed at least 40 times during the study period were analyzed.Results: Of 860 procedures that met study criteria, 492 operations were one of six procedures performed at least 40 times, which were anterior cervical discectomy and fusion, cerebrospinal fluid (CSF) shunt insertion, CSF shunt revision, lumbar laminectomy, intracranial hematoma evacuation, and non-skull base, supratentorial parenchymal brain tumor resection. An additional resident was associated with a 35.1-min decrease (p = .01) in operative duration for lumbar laminectomies. However, for intracranial hematoma evacuations, an extra resident was associated with a 24.1 min increase (p = .03) in procedural length. There were no significant differences observed in the other four surgeries.Conclusion: An additional resident may lengthen duration of intracranial hematoma evacuations. However, two residents scrubbed-in were associated with decreased lumbar laminectomy duration. Overall, an extra resident does not increase procedural duration, total operating room utilization, EBL, or post-operative LOS. Allowing two residents to scrub in may be a safe and cost-effective method of educating neurosurgical residents.
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Affiliation(s)
- Anthony V Nguyen
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - William S Coggins
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Rishabh R Jain
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel W Branch
- Division of Neurosurgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Randall Z Allison
- Division of Neurosurgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Ken Maynard
- Division of Neurosurgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Rishi R Lall
- Division of Neurosurgery, The University of Texas Medical Branch, Galveston, TX, USA
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Abstract
Background E-learning platforms, especially the online neurosurgical video sharing sites, are playing a key role in the dissemination of knowledge related to the essential steps of operative neurosurgery. Aim A national survey was undertaken to assess the utility of neurosurgical operative videos exhibited on the online video-sharing sites. Materials and Methods Resident trainees in neurosurgery, as well as junior and senior consultant neurosurgeons practicing in India were provided, on the Google platform, a questionnaire consisting of nine multiple-choice questions and a space for remarks. 520 people were contacted using e mail and/or whattsapp modalities, out which 98 responses were considered valid. Results Majority (n = 87, 88.8%) of the responders voted that internet videos have helped them in improving their surgical skills. There was no statistically significant difference between people working in rural and urban areas in this regard (P = 0.517). Both senior and junior neurosurgeons were utilizing these online videos for enhancing their surgical skills, and there was no statistically significant difference regarding the perception of the usefulness of these online video channels between the two groups (P = 0.660). However, the response rate to the questionnaires sent was only 18.84%. Conclusions Online video-sharing platforms are useful, especially in a country like India with diverse neurosurgical infrastructure. The need for the development and maintenance of a dedicated, high-quality, structured video bank through collaboration and cooperation of high volume centers and institutes of repute in India is strongly advocated.
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Affiliation(s)
- P Krishna Kumar
- Department of Neurosurgery, Government T D Medical College, Alappuzha, Kerala, India
| | - Biju Bhadran
- Department of Neurosurgery, Government T D Medical College, Alappuzha, Kerala, India
| | - G Harrison
- Department of Neurosurgery, Government T D Medical College, Alappuzha, Kerala, India
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Newman WC, Chang YF, Lunsford LD. Professionalism and performance issues during neurosurgical training and job satisfaction after training: a single training center 50-year experience. J Neurosurg 2019; 131:245-251. [PMID: 30117767 DOI: 10.3171/2018.3.jns172347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/01/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurosurgery is often self-selecting. Concern has been raised that residents in the millennial era (born between 1982 and 2004) may have more serious professionalism and performance issues (PPIs) during training compared to prior trainees. Serious PPIs were defined as concerns that led to specific resident disciplinary actions ranging from initial warnings to termination. In order to evaluate this concern, the authors retrospectively reviewed a 50-year experience at a single training center. They then prospectively surveyed living graduates of the program to assess variations in practice patterns and job satisfaction over 5 decades. METHODS The PPIs of 141 residents admitted for training at the University of Pittsburgh (subsequently UPMC) Department of Neurological Surgery were reviewed by decade starting in 1971 when the first department chair was appointed. The review was conducted by the senior author, who served from 1975 to 1980 as a resident, as a faculty member since 1980, and as the resident director since 1986. A review of resident PPIs between 1971 and 1974 was performed in consultation with a senior faculty member active at that time. During the last decade, electronic reporting of PPIs was performed by entry into an electronic reporting system. In order to further evaluate whether the frequency of PPIs affected subsequent job satisfaction and practice patterns after completion of training, the authors surveyed living graduates. RESULTS There was no statistically significant difference by decade in serious PPIs. Although millennial residents had no significant increase in the reporting of serious PPIs, the increased use of electronic event reporting over the most recent 2 decades coincided with a trend of increased reporting of all levels of suspected PPIs (p < 0.05). Residents surveyed after completion of training showed no difference by decade in types of practice or satisfaction-based metrics (p > 0.05) but reported increasing concerns related to the impact of their profession on their own lifestyle as well as their family's. CONCLUSIONS There was no statistically significant difference in the incidence of serious PPIs over 5 decades of training neurosurgery residents at the authors' institution. During the millennial era, serious PPIs have not been increasing. However, reporting of all levels of PPIs is increasing coincident with the ease of electronic reporting. There was remarkably little variance in satisfaction metrics or type of practice over the 5 decades studied.
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Abstract
Introduction: We present a low cost model that can be used to improve a trainee's skills in spinal dural closure. Development of microsurgical skills in a simulated environment provides a safe environment in which patients are protected. We argue that this is likely to improve the quality of dural closure, especially for surgeons early in their training and may lead to a commensurate reduction in post-operative CSF leak. Method: In our model, two consultant spine surgeons assessed the ability of participants to close the spinal dura. Participants were scored both quantitatively (time taken to complete the task) and qualitatively under the category of "surgical performance"- assessed by video and inspection of the closed dural substitute. Results: The cohort under assessment included senior and newly appointed consultants, clinical fellows and thirteen specialty trainees. 10 trainees were assessed a second time and a significant majority improved on both domains: 8 (80%) were faster on their second attempt; surgical performance scores also improved in the majority of trainees (90%). Conclusion: Our results, albeit with small numbers, show that a large proportion of trainees improve with practice with a reduction in overall task time and an improvement in surgical performance. Our model is cost-effective and easy to reproduce: simulation need not be an expensive exercise. This study further validates the use of simulation in modern neurosurgical training.
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Affiliation(s)
- Deborah Ferguson
- a Department of Neurosurgery , Institute of Neurological Sciences , Glasgow , UK
| | - Kevin Agyemang
- a Department of Neurosurgery , Institute of Neurological Sciences , Glasgow , UK
| | - Christopher Barrett
- a Department of Neurosurgery , Institute of Neurological Sciences , Glasgow , UK
| | - Calan Mathieson
- a Department of Neurosurgery , Institute of Neurological Sciences , Glasgow , UK
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McKenna G. Neurosurgery Trainees' Perspectives of the 'Mock Viva'. MedEdPublish (2016) 2018; 7:248. [PMID: 38415016 PMCID: PMC10898496 DOI: 10.15694/mep.2018.0000248.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
This article was migrated. The article was marked as recommended. The 'viva voce' examination has been a tradition in surgical training for over a century, and remains a key element of the 'Fellowship of the Royal College of Surgeons' (FRCS) Examination, which neurosurgery trainees must pass to complete their training. The aims of this study were to evaluate the educational value of an annual 'mock viva' as a formative assessment tool for neurosurgical trainees during their eight year training programme, to identify barriers to participating in the mock viva and to explore how these might be attenuated to increase levels of engagement . A mixed deductive and inductive methodology was employed for the study design and qualitative data analysis. Semi structured interviews were conducted with two cohorts of trainees (three pre-FRCS and three post-FRCS). Six overarching themes emerged from thematic analysis of coded qualitative data - 'insight', 'performance', 'simulation', 'stress', 'differentiation strategies', and 'assessment versus learning'. Gaining insight into the format, standard, marking scheme, and processes of the final FRCS examination were considered key elements of the educational value of the mock viva and these were perceived to be acquired through high fidelity simulation of the FRCS exam, with high quality feedback on performance. The opportunity to observe the assessment of others offered insight into one's performance relative to peers as well as insight the perspective of the examiner conducting the assessment. Whilst they acknowledged negative 'stress' factors associated with the mock viva, post-FRCS trainees underscored the benefits of learning from substandard performances; of reflecting on these experiences and on the feedback they received, and they suggested that junior trainees lacked insight into the educational value of what are often perceived to be 'negative' experiences. Junior trainees were concerned that the potential learning value of the mock viva process was limited by their clinical knowledge and experience in the early stage of training. These overarching themes point to areas which could be targeted to enhance the educational value of the mock viva and to address the paradox of poor uptake amongst junior trainees.
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Choque-Velasquez J, Kozyrev DA, Colasanti R, Thiarawat P, Intarakhao P, Jahromi BR, Hernesniemi J. The open access video collection project "Hernesniemi's 1001 and more microsurgical videos of Neurosurgery": A legacy for educational purposes. Surg Neurol Int 2017; 8:188. [PMID: 28868200 PMCID: PMC5569399 DOI: 10.4103/sni.sni_158_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/06/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Neurosurgical educational programs and courses are helpful to improve the quality of training. Moreover, nowadays, online activities may represent a very useful tool to globally enhance neurosurgical education. The "Hernesniemi's 1001 and more microneurosurgical videos" project aims to show the microsurgical style developed by the senior author and his TEAMs in more than 40 years of experience. METHODS More than 1100 high-definition videos of microneurosurgical operations performed by the senior author were carefully edited. These videos illustrate the philosophy of "simple, clean, fast and preserving the normal anatomy" while offering a step by step guide of different neurosurgical procedures. RESULTS All the aforementioned material is well organized in an electronic videobook, freely available in Surgical Neurology International. The book also includes comments of great current neurosurgeons and writings of the authors and editors. CONCLUSION We are sure that our project will be able to instill in and spread across the neurosurgical community the microneurosurgical style of the senior author, thus representing an efficient educational tool for surgeons all around the world.
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Affiliation(s)
| | - Danil A Kozyrev
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Roberto Colasanti
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.,Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | | | | | | | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
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Abstract
Microvascular anastomosis procedure has become an essential practice for the management of most neurovascular diseases. Increasing use of neurosurgical techniques necessitates intensive laboratory training in microsurgery. Umbilical artery is used for quantifiable representation to set up microvascular anastomosis model for the beginners. These arteries are found to be between 4 and 5 mm in diameter. Chicken wings are set up as second anastomosis model. Five to six centimeter long brachial artery extracted from a chicken is measured approximately 1-2 mm in diameter. These arteries are practiced for end-to-end, end-to-side, or side-to-side anastomosis under the microscope. Umbilical cord and chicken wing model hold several advantages. These essentials are inexpensive, convenient to manage, and easy to obtain for educational purposes. They neither need detailed facilities for maintenance like in animal model nor any anesthetic prerequisite. Moreover, the diameter and structure of the material are identical to those of human cortical vessels. Low-cost laboratory training during residency is more relevant in source restraint areas. It has several added benefits in refining the procedural dexterity on anastomosing smaller size vessel identical to a cortical vessel of middle cerebral artery and distal branches of the superficial temporal artery.
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Abstract
There has been concern that the move towards generalism means that specialties, such as neurosurgery, are being pushed out of the undergraduate syllabus. Surveys were created, along with the Society of British Neurological Surgeons, and sent to medical school representatives (MSRs) and neurosurgery programme directors (NPDs) in the United Kingdom (UK). 60% of MSRs and 71% of NPDs responded. Neurosurgical topics were taught by a variety of specialties, and in one medical school, a MSR said that neurosurgery was not taught at all. 83% of MSRs and 80% of NPDs said that neurosurgeons should be more involved in undergraduate education, with 70% of NPDs saying that their unit would be willing to have increased involvement. All NPDs, but only 72% of MSRs, said that neurosurgery should be taught in medical school. Those MSRs who disagreed opined that it was a postgraduate subject, and could be difficult to engage all students. The majority of MSRs and NPDs thought that neurosurgery guidelines would be useful. The most popular forms of guidance were in the forms of curriculum/guidelines, website and powerpoint presentations. It is therefore recommended that neurosurgeons, under the umbrella of the Society of British Neurological Surgeons, create national guidelines for the teaching of undergraduate students; to aid their educational colleagues and ensure that accurate, standardised teaching occurs. Care must be taken not to be over-prescriptive in these endeavours.
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Affiliation(s)
| | - Anne J Moore
- a Southwest Neurosurgery Centre, Derriford Hospital , Plymouth , UK
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Gragnaniello C, Gagliardi F, Chau AMT, Nader R, Siu A, Litvack Z, Luca BD, Seex K, Mortini P, Caputy AJ, Al-Mefty O. Intracranial injectable tumor model: technical advancements. J Neurol Surg B Skull Base 2014; 75:301-8. [PMID: 25276597 DOI: 10.1055/s-0034-1368148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 11/22/2013] [Indexed: 10/25/2022] Open
Abstract
Background and Objectives Few simulation models are available that provide neurosurgical trainees with the challenge of distorted skull base anatomy despite increasing importance in the acquisition of safe microsurgical and endoscopic techniques. We have previously reported a unique training model for skull base neurosurgery where a polymer is injected into a cadaveric head where it solidifies to mimic a skull base tumor for resection. This model, however, required injection of the polymer under direct surgical vision via a complicated alternative approach to that being studied, prohibiting its uptake in many neurosurgical laboratories. Conclusion We report our updated skull base tumor model that is contrast-enhanced and may be easily and reliably injected under fluoroscopic guidance. We have identified a map of burr holes and injection corridors available to place tumor at various intracranial sites. Additionally, the updated tumor model allows for the creation of mass effect, and we detail the variation of polymer preparation to mimic different tumor properties. These advancements will increase the practicality of the tumor model and ideally influence neurosurgical standards of training.
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Affiliation(s)
- Cristian Gragnaniello
- Macquarie Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Filippo Gagliardi
- Department of Neurosurgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Anthony M T Chau
- Macquarie Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Remi Nader
- Department of Neurosurgery, Texas Center for Neurosciences, Beaumont, Texas, United States
| | - Alan Siu
- Department of Neurosurgery, George Washington University, Washington District of Columbia, United States
| | - Zachary Litvack
- Department of Neurosurgery, George Washington University, Washington District of Columbia, United States
| | - Bruno De Luca
- Department of Experimental Medicine, Second University of Naples, Naples, Italy
| | - Kevin Seex
- Macquarie Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Pietro Mortini
- Department of Neurosurgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Anthony J Caputy
- Department of Neurosurgery, George Washington University, Washington District of Columbia, United States
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
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Hayden MG, Hughes S, Hahn EJ, Aryan HE, Levy ML, Jandial R. Maria Auxiliadora Hospital in Lima, Peru as a model for neurosurgical outreach to international charity hospitals. Childs Nerv Syst 2011; 27:145-8. [PMID: 20490509 DOI: 10.1007/s00381-010-1170-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 04/29/2010] [Indexed: 10/25/2022]
Abstract
INTRODUCTION A myriad of geopolitical and financial obstacles have kept modern neurosurgery from effectively reaching the citizens of the developing world. Targeted neurosurgical outreach by academic neurosurgeons to equip neurosurgical operating theaters and train local neurosurgeons is one method to efficiently and cost effectively improve sustainable care provided by international charity hospitals. The International Neurosurgical Children's Association (INCA) effectively improved the available neurosurgical care in the Maria Auxiliadora Hospital of Lima, Peru through the advancement of local specialist education and training. METHODS Neurosurgical equipment and training were provided for the local neurosurgeons by a mission team from the University of California at San Diego. RESULTS At the end of 3 years, with one intensive week trip per year, the host neurosurgeons were proficiently and independently applying microsurgical techniques to previously performed operations, and performing newly learned operations such as neuroendoscopy and minimally invasive neurosurgery. CONCLUSION Our experiences may serve as a successful template for the execution of other small scale, sustainable neurosurgery missions worldwide.
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Mutoh T, Ishikawa T, Ono H, Yasui N. A new polyvinyl alcohol hydrogel vascular model (KEZLEX) for microvascular anastomosis training. Surg Neurol Int 2010; 1:74. [PMID: 21170365 PMCID: PMC2997226 DOI: 10.4103/2152-7806.72626] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 09/29/2010] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Microvascular anastomosis is a challenging neurosurgical technique that requires extensive training for one to master it. We developed a new vascular model (KEZLEX, Ono and Co., Ltd., Tokyo, Japan) as a non-animal, realistic tool for practicing microvascular anastomosis under realistic circumstances. METHODS The model was manufactured from polyvinyl alcohol hydrogel to provide 1.0-3.0 mm diameter (available for 0.5-mm pitch), 6-8 cm long tubes that have qualitatively similar surface characteristics, visibility, and stiffness to human donor and recipient arteries for various bypass surgeries based on three-dimensional computed tomography/magnetic resonance imaging scanning data reconstruction using visible human data set and vessel casts. RESULTS Trainees can acquire basic microsuturing techniques for end-to-end, end-to-side, and side-to-side anastomoses with handling similar to that for real arteries. To practice standard deep bypass techniques under realistic circumstances, the substitute vessel can be fixed to specific locations of a commercially available brain model with pins. CONCLUSION Our vascular prosthesis model is simple and easy to set up for repeated practice, and will contribute to facilitate "off-the-job" training by trainees.
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Affiliation(s)
- Tatsushi Mutoh
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita, 6-10 Senshu-Kubota-machi, Akita 010-0874, Japan
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