Pilot Study in Theoretical and Hands-On Experience and its Contribution to Learning of Residents and Young Trainees in Neurosurgery. The Importance of Surgical Anatomy Laboratories as Part of Training

Introduction: The performance of neurosurgical approaches can be challenging mainly for young residents and trainees due to the complexity of the skull base anatomy and three-dimensional visualization. To perform such procedures, theoretical study is required and association with training exercises and dissections using specimens can offer a significant and useful opportunity for young surgeons prior the surgery itself. Therefore, our goal was to present the first part of a comprehensive 1-year-method used in a surgical laboratory to improve knowledge and surgical skills of residents in neurosurgery in compliance with the Accreditation Council for Graduate Medical Education (ACGME) regulations.

Materials and Methods: The method consisted of a 1-year program of basic anatomy and exercises and surgical approaches and dissections. During the first 6 months lectures were given to young residents in which basic aspects of neuroanatomy and cranial base were presented by neurosurgeons considering their expertise. The meetings included 2D and 3D presentations, and lasted 30 minutes weekly. Fifteen-minute quizzes were offered to guarantee the learning of concepts previously described within the same session. Inside the surgical laboratory, the first basic exercise consisted of drilling empty eggshells with a 2-mm diamond burr. The second exercise consisted of carving and drilling nonhuman bone with five different burrs. The residents were offered an ample deadline to perform such exercises as their scheduled allowed, in compliance with ACGME hour restrictions. The practical exercises were anonymized and evaluated by three different neurosurgeons independently. Surveys were distributed to the residents to evaluate their perception of the program.

Results: All the residents performed both drilling tasks and the quizzes. Three winners per practical exercise were selected taking into account technical excellence and artistic qualities. Although residents of all levels were evaluated without taking into account their training level, winners of the practical exercise included junior, middle level, and senior residents. Both tasks required gentle and precise movements of the hand holding the drill guaranteeing safe maneuvers without violation of the eggshells or the bone inner cortex. A PhD in anatomy was present to supervise the exercises at all times. 3D presentations were the main source to provide lectures with professional and high-quality images. These images of previous dissection in specimens and cadavers allowed the perception of depth and demonstrated the complexity of dissections expected to be done inside the laboratory. The quizzes involved identification of anatomical structures in dissection pictures. Eight residents answered the questionnaire, 87.5% of the residents considered helpful the current program, and acknowledged the importance of surgical anatomy.

Conclusion: Professor Albert L. Rhoton Jr., stated that to perform neurosurgical approaches considered “accurate, gentle, and safe,” neuroanatomy needs to be comprehended. This pilot study intends to include a structured theoretical and practical neuroanatomy curriculum in neurosurgical residency in compliance with ACGME regulations. We strongly believe that the time spent inside a surgical anatomy laboratory can be crucial to give additional experience and improve skills of young trainees and residents. Prospective evaluation of this program will be performed to assess its objective value in neurosurgical training.

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021