Training in Endoscopic Endonasal Neurosurgical Procedures: A Systematic Review of Available Models

Edoardo Porto; Alejandra Rodas; Hanyao Sun; Juan Manuel Revuelta Barbero; Megan Cosgrove; Leonardo Tariciotti; Alessandro Perin; Gabriel Zada; Francesco DiMeco; Clementino Arturo Solares; Tomas Garzon-Muvdi; Gustavo Pradilla

doi:10.1055/a-2319-0425

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2025; 86(03): 278-294
DOI: 10.1055/a-2319-0425

Original Article

Training in Endoscopic Endonasal Neurosurgical Procedures: A Systematic Review of Available Models

Edoardo Porto ^*

¹Department of Neurosurgery, Emory University, Atlanta, Georgia, United States

²Department of Neurosurgery, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy

,

Alejandra Rodas^*

³Department of Otorhinolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, United States

,

Hanyao Sun

¹Department of Neurosurgery, Emory University, Atlanta, Georgia, United States

,

Juan Manuel Revuelta Barbero

¹Department of Neurosurgery, Emory University, Atlanta, Georgia, United States

,

Megan Cosgrove

¹Department of Neurosurgery, Emory University, Atlanta, Georgia, United States

,

Leonardo Tariciotti

¹Department of Neurosurgery, Emory University, Atlanta, Georgia, United States

,

Alessandro Perin

²Department of Neurosurgery, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy

,

Gabriel Zada

⁴Department of Neurosurgery, USC Keck School of Medicine, University of Southern California, Los Angeles, California, United States

,

Francesco DiMeco

²Department of Neurosurgery, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy

⁵Department of Neurological Surgery, Johns Hopkins Medical School, Hunterian Brain Tumor Research Laboratory, Baltimore, Maryland, United States

⁶Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

,

Clementino Arturo Solares

²Department of Neurosurgery, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy

,

Tomas Garzon-Muvdi

¹Department of Neurosurgery, Emory University, Atlanta, Georgia, United States

,

Gustavo Pradilla

¹Department of Neurosurgery, Emory University, Atlanta, Georgia, United States

› Author Affiliations

Abstract

Background Proficiency in endoscopic endonasal neurosurgery (EEN) requires a unique skill set and is associated with a steep learning curve. Endoscopic simulation models present an opportunity for trainees to enhance their surgical skills and anatomical knowledge in a risk-free environment. To date, four main categories of training modalities have been recorded: cadaveric, synthetic, animal, and virtual reality (VR) models.

Objective To analyze the features, advantages, and disadvantages of each EEN training model, describe the stages of simulation training, and propose future directions and an algorithm for EEN training.

Methods A comprehensive search was performed including studies published before August 2023. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed in the search and selection of studies included. Terms for searching title and abstract were (“simulation”) AND (“endoscopic endonasal”) AND (“neurosurgery”). Articles were screened for duplicates.

Results We identified 176 references, and 43 studies met the inclusion criteria. Twelve articles described cadaveric models, with 7 of them studying internal carotid artery injury management and 3 of them cerebrospinal leak management; 14 articles illustrated synthetic models, 1 article described animal models, and 16 articles outlined VR simulations.

Conclusion Cadaveric models provide realistic hands-on surgical training with acceptable cost and remain the gold standard method for training. Synthetic models are most effective for preoperative surgical planning and animal models are best suited for testing of hemostatic techniques. VR simulations may become the primary training tool for novices to acquire basic anatomical knowledge as their role in advanced surgical planning is evolving.

Keywords

cadaveric models - endoscopic endonasal surgery - simulation - training - virtual reality

Full Text

References

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