State of the Union in Open Neurovascular Training

Fredrickson, Vance L; Strickland, Ben A.; Rāviņa, Kristīne; Rennert, Robert C.; Donoho, Daniel A.; Buchanan, Ian A.; Russin, Jonathan J.; Mack, William J.; Giannotta, Steven L.

doi:10.1016/j.wneu.2018.10.099

Cited by 16 publications

(15 citation statements)

References 23 publications

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“…North American experience has allowed us to learn that accredited fellowships often provide a larger exposure to vascular cases. 4 Lastly, dedicated young neurosurgeons with a particular interest in vascular neurosurgery, and a willingness to travel abroad, are needed to make the most of the fellowship.…”

Section: Framework For a Cerebrovascular Fellowshipmentioning

confidence: 99%

Letter: Training of Microsurgical Aneurysm Clipping in the Endovascular Era: Towards Structured Fellowship Programs in Europe

Haeren¹,

Schwartz²,

Satopää³

et al. 2021

Neurosurg.

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Section: Framework For a Cerebrovascular Fellowshipmentioning

confidence: 99%

Letter: Training of Microsurgical Aneurysm Clipping in the Endovascular Era: Towards Structured Fellowship Programs in Europe

Haeren¹,

Schwartz²,

Satopää³

et al. 2021

Neurosurg.

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“…The main advantages of the anterior clinoidectomy lie in a more proximal control of the ICA, including the cavernous segment, and wider surgical freedom around the aneurysm neck. It must be stressed that a paramount aspect for the successful management of carotid-ophthalmic aneurysms, as well as other types of aneurysms, remains the constant neurovascular training (31)(32)(33).…”

Section: Technical Considerationsmentioning

confidence: 99%

Optic Foraminotomy for Clipping of Superior Carotid-Ophthalmic Aneurysms

et al. 2021

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Background: Carotid-ophthalmic aneurysms usually cause visual problems. Its surgical treatment is challenging because of its anatomically close relations to the optic nerve, carotid artery, ophthalmic artery, anterior clinoid process, and cavernous sinus, which hinder direct access. Despite recent technical advancements enabling risk reduction of this complication, postoperative deterioration of visual function remains a significant problem. Therefore, the goal of preserving and/or improving the visual outcome persists as a paramount concern.Objective: We propose optic foraminotomy as an alternative microsurgical technique for dorsal carotid-ophthalmic aneurysms clipping. As a secondary objective, the step by step of that technique and its benefits are compared to the current approach of anterior clinoidectomy.Methods: We present as an example two patients with superior carotid-ophthalmic aneurysms in which the standard pterional craniotomy, transsylvian approach, and optic foraminotomy were performed. Surgical techniques are presented and discussed in detail with the use of skull base dissections, microsurgical images, and original drawings.Results: Extensive opening of the optic canal and optic nerve sheath was successfully achieved in all patients allowing a working angle with the carotid artery for correct visualization of the aneurysm and further clipping. Significant visual acuity improvement occurred in both patients because of decompression of the optic nerve.Conclusion: Optic foraminotomy is an easy and recommended technique for exposing and treating superior carotid-ophthalmic aneurysms and allowing optic nerve decompression during the first stages of the procedure. It shows several advantages over the current anterior clinoidectomy technique regarding surgical exposure and facilitating visual improvement.

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“…), AC-GME guidelines, and graduating resident case logs over recent years (Table 3), as well as recent literature on open cerebrovascular volume. 33…”

Section: Hml Within Existing Resident Education Paradigmmentioning

confidence: 99%

Developing microsurgical milestones for psychomotor skills in neurological surgery residents as an adjunct to operative training: the home microsurgery laboratory

Abecassis

Sen

Ellenbogen

et al. 2020

Journal of Neurosurgery

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OBJECTIVEA variety of factors contribute to an increasingly challenging environment for neurological surgery residents to develop psychomotor skills in microsurgical technique solely from operative training. While adjunct training modalities such as cadaver dissection and surgical simulation are embraced and practiced at our institution, there are no formal educational milestones defined to help residents develop, measure, and advance their microsurgical psychomotor skills in a stepwise fashion when outside the hospital environment. The objective of this report is to describe an efficient and convenient “home microsurgery lab” (HML) assembled and tested by the authors with the goal of supporting a personalized stepwise advancement of microsurgical psychomotor skills.METHODSThe authors reviewed the literature on previously published simulation practice models and designed adjunct learning modules utilizing the HML. Five milestones were developed for achieving proficiency with each graduated exercise, referencing the Accreditation Council for Graduate Medical Education (ACGME) guidelines. The HML setup was then piloted with 2 neurosurgical trainees.RESULTSThe total cost for assembling the HML was approximately $850. Techniques for which training was provided included microinstrument handling, tissue dissection, suturing, and microanastomoses. Five designated competency levels were developed, and training exercises were proposed for each competency level.CONCLUSIONSThe HML offers a unique, entirely home-based, affordable adjunct to the operative neurosurgical education mandated by the ACGME operative case logs, while respecting resident hospital-based education hours. The HML provides surgical simulation with specific milestones, which may improve confidence and the microsurgical psychomotor skills required to perform microsurgery, regardless of case type.

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State of the Union in Open Neurovascular Training

Cited by 16 publications

References 23 publications

Letter: Training of Microsurgical Aneurysm Clipping in the Endovascular Era: Towards Structured Fellowship Programs in Europe

Letter: Training of Microsurgical Aneurysm Clipping in the Endovascular Era: Towards Structured Fellowship Programs in Europe

Optic Foraminotomy for Clipping of Superior Carotid-Ophthalmic Aneurysms

Developing microsurgical milestones for psychomotor skills in neurological surgery residents as an adjunct to operative training: the home microsurgery laboratory

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