Abstract
Neurosurgery resident training must evolve with changes in medical education guidelines. Traditional cadaveric and synthetic models dominate current training curricula but can be improved upon. This study evaluated the use of whole-body donor cadavers preserved through a proprietary procedure, with intubation, ventilation, whole-blood perfusion, and simulated cerebrospinal fluid flow. This model creates a novel spinal surgery experience with a realistically simulated operating room suite and high-fidelity tissue.
Whole-body donor cadavers underwent preservation within a week of death and then were stored in the hospital morgue. Endotracheal tube intubation, with ventilator support, simulated patient ventilation, and expired blood products from the hospital's internal blood bank were used for recreation of arterial flow after internal carotid artery cannulation. Intrathecal cerebrospinal fluid flow used normal saline from a needle inserted in the occiput-C1 interval into the foramen magnum. Attending (n = 5) and resident (n = 7) neurosurgeons performed thoracolumbar laminectomy with medial facetectomy, and subjective measures comparing the simulation with the genuine procedure were recorded using standardized surveys.
When comparing the simulation with the genuine procedure on a 15-point Likert scale (1 = no similarity; 15 = completely identical), mean (SD; range) ratings for attending and resident participants were 12.8 (1.33; 11-15) and 12.57 (0.79; 12-14) (P = .76 [-2.10, 1.64]), respectively. On a similar scale evaluating whether the model facilitated surgical technique development and whether this simulation was an upgrade to their current training models (1 = absolutely no; 15 = absolutely yes), the mean (SD; range) rating for the attending group was 14.8 (0.4; 14-15). The resident group gave unanimous ratings of 15 (P = .37 [-0.36, 0.76]).
This model used operating room suite replication and high-quality tissue for improved spinal surgical training. The combination of characteristics allowed for an experience closely replicating spinal surgery, providing a training environment not possible with traditional models.