The Learning Curve in Skull Base Surgery Part 1–From Historical-Philosophical Concepts to Microsurgical Lab Training

Abstract

The learning curve reflects surgeons' experience in managing several patients with the same disease. In skull base surgery, the professional's place on the curve could be related to the number of times the same procedure was performed. Where does curve begin? What amount of training is necessary prior to its application in surgical settings? What were the results of the first few skull base tumor surgeries performed by a surgeon who goes on to produce excellent results, and how is reflected in the start of their learning curve? The only way for neurosurgeons to improve their results from the start is with prior training in the microsurgery laboratory. This learning technique is essential to maximize the chance of success of a neurosurgical procedures, minimizing the morbidity rate to which patients are subjected by less experienced neurosurgeons. This article is divided in two parts, and its purpose is to show how training in the microsurgical laboratory fits into the construction of knowledge about skull base surgery, based on authors' experience and reflections. This first part discusses the technical, psychological, and philosophical aspects of medical knowledge, primarily addressing those training in skull base surgery, the principles of some selected philosophical currents, and their influence on the development of current medical knowledge.

Keywords

skull-base - learning curve - microsurgical laboratory

Note

Some small parts of this article were published previously in Portuguese by the senior author, * but with a different focus on the learning curve. Following the Brazilian Association for Technical Standards (ABNT) and copyright rules (lei número 9.610), these parts are identified by quotation marks.

*Isolan GR: A construção do conhecimento pelo jovem neurocirurgião: ética, ciência e a importância do treinamento em laboratório de microcirurgia. J Bras Neurocirurg 20 (3): 314–334, 2009.

This paper, divided in two parts, is a tribute to Professor Evandro de Oliveira, MD, PhD. (1945 - 2021)

Publication History

Received: 29 July 2022

Accepted: 18 August 2022

Article published online:
16 December 2022

• References

• 1 Wright TP. Factors Affecting the Cost of Airplanes. J Aeronaut Sci 1936; 3 (04) 122-128
• 2 Yaşargil MG. Microneurosurgery. Vols I, II, and IVB. Georg Thieme Verlag; Stuttgart: 1996
• 3 Yaşargil MG. Reflections of a neurosurgeon. Clin Neurosurg 1988; 34: 16-21
• 4 Yaşargil MG. A legacy of microneurosurgery: memoirs, lessons, and axioms. Neurosurgery 1999; 45 (05) 1025-1092
• 5 Yaşargil MG, Chandler WF, Jabre AF, Roth P. Neurosurgical horizons. Clin Neurosurg 1988; 34: 22-41
• 6 Traynelis VC. The geometry of education: patterns for growth. Clin Neurosurg 2005; 52: 1-5
• 7 Durant W. . (1996) História da Filosofia. Ed. Nova Cultural, São Paulo
• 8 Molyneux AJ, Kerr RS, Yu LM. et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005; 366 (9488): 809-817
• 9 Carlson ML, Vivas EX, McCracken DJ. et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Hearing Preservation Outcomes in Patients With Sporadic Vestibular Schwannomas. Neurosurgery 2018; 82 (02) E35-E39
• 10 Germano IM, Sheehan J, Parish J. et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Radiosurgery and Radiation Therapy in the Management of Patients With Vestibular Schwannomas. Neurosurgery 2018; 82 (02) E49-E51
• 11 Hadjipanayis CG, Carlson ML, Link MJ. et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Surgical Resection for the Treatment of Patients With Vestibular Schwannomas. Neurosurgery 2018; 82 (02) E40-E43
• 12 Roser F, Tatagiba MS. The first 50s: can we achieve acceptable results in vestibular schwannoma surgery from the beginning?. Acta Neurochir (Wien) 2010; 152 (08) 1359-1365
• 13 Lawton MT, Lang MJ. The future of open vascular neurosurgery: perspectives on cavernous malformations, AVMs, and bypasses for complex aneurysms. J Neurosurg 2019; 130 (05) 1409-1425
• 14 Buchman CA, Chen DA, Flannagan P, Wilberger JE, Maroon JC. The learning curve for acoustic tumor surgery. Laryngoscope 1996; 106 (11) 1406-1411
• 15 Elsmore AJ, Mendoza ND. The operative learning curve for vestibular schwannoma excision via the retrosigmoid approach. Br J Neurosurg 2002; 16 (05) 448-455
• 16 Moffat DA, Hardy DG, Grey PL, Baguley DM. The operative learning curve and its effect on facial nerve outcome in vestibular schwannoma surgery. Am J Otol 1996; 17 (04) 643-647
• 17 Samii M, Gerganov V, Samii A. Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg 2006; 105 (04) 527-535
• 18 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections. Neurosurgery 1997; 40 (02) 248-260 , discussion 260–262
• 19 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 1997; 40 (01) 11-21 , discussion 21–23
• 20 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve–preservation and restitution of function. Neurosurgery 1997; 40 (04) 684-694 , discussion 694–695
• 21 Dunn IF, Bi WL, Erkmen K. et al. Medial acoustic neuromas: clinical and surgical implications. J Neurosurg 2014; 120 (05) 1095-1104