Simulation in Skull-Base Neurosurgery

Introduction: There has been major concern for neurosurgical educators to define a curriculum that can identify resident’s technical and conceptual limitations, and can address to improve surgical competence. The present study analyses development of skull base neurosurgery skills development program highlighting formulation and standardization of structured low and high-fidelity simulation modules, and evaluation of efficacy in training neurosurgeons with formative and summative assessment tools.

Methods: A structured modular skull base neurosurgery simulation has been proposed which includes microneurosurgery, high speed drilling and neuroendoscopy comprising basic (7), intermediate (7), and advanced (14) simulation modules. 85 regular residents and 179 short-term visiting trainees were trained over 8,586 skills training sessions; 419 residents attended 25 week-end sessions, and 248 graduate neurosurgeons were trained in 16 workshops.

Results: Summative assessment was done on 71 board certified neurosurgeons, of which majority had average competence in all three modules; microsurgery, drilling, neuroendoscopy. Young neurosurgeons <33 years scored better in microsuturing (p = 0.03) and drilling (p = 0.006). Freshly certified neurosurgeons performed better in microsuturing (p = 0.003) and drilling (p = 0.001). Similar was the finding from neurosurgeons trained at central institutes, though it was significant in microsuturing (p = 0.01). Difference in performance in neuro-endoscopy in all groups did not reach significant levels. Formative assessments were done in trainees who attended short-term repetitive training in each module (49, 31, and 30 trainees in microsurgery, drilling, neuroendoscopy, respectively) to assess their degree of improvement with practice. Training improved performance in microsuturing, drilling, and neuroendoscopy by 44.2, 12.73, 17.26%, respectively (p = 0.001). Interval-based feedback analysis was taken from trainees (61.6% response rate) in which more than 70% reported good to excellent benefit from the training in their real surgical practice.

Conclusion: We suggest structured modular validated simulation program to supplement the existing skull base neurosurgery training, which would help in improving learning curve outside operation rooms, at convenience and individualized needs of trainees under supervision, and help in skills translation without endangering patients.