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.
Fig. 1
