Background: The difficulty of learning curve in different microsurgical regions is one of the most challenging factors that affect neurosurgeon’s life. Two of the delicate areas are the suprasellar intraventricular a...Background: The difficulty of learning curve in different microsurgical regions is one of the most challenging factors that affect neurosurgeon’s life. Two of the delicate areas are the suprasellar intraventricular and pontocerebellar region. High level of microsurgery or endoscopic surgery requires virtuosity, which can not be learnt only by assisting. Even among the well skilled neurosurgeons who work in big centers we can often hear “in spite of centralization there are not enough operations available to keep the high level of our skills”. The situation of surgeons working at mid centers is more difficult especially on duties. Methods: Huge number of scientific articles demonstrate the importance of different types of cadaver practice, but always did not pay enough attention to the daily fast fresh cadaver exercises. Focusing on lifelong every day practice we examined the difficulties of learning curve in intraventricular and pontocerebellar region and try to give some useful advice for practicing on fresh cadavers on a daily basis. We offer a simple endovascular fresh cadaver model for practicing. Results: We have performed more than 800 quick (60 - 90 minutes long) routine practice sessions in these two regions during last 18 years. We found that implantation a modelized pathology and removing it by microscopical or endoscopic way without causing injuries to sensitive structures seems to be the most practical way of fast everyday training. Nerves and vascular bypass sutures are also excellent practical method. Conclusions: We have focused on daily fast fresh cadaver practice as a novel training method like used in professional sport and art. After 18 years experience we can state that, for mastering the microsurgery of pontocerebellar and intraventricular region, which is one of the most challenging regions minimum 100 fresh cadaver practice sessions need before performing the operation. We believe this region should be part of fast fresh cadaver microsurgical practice routine programme on daily bases, minimum one time/week/person.展开更多
Purpose: Challenging cases in neurosurgery require experience, which is gained by operating on a number of similarly difficult cases. However, even in large population centers, there are extremely rare cases, such as ...Purpose: Challenging cases in neurosurgery require experience, which is gained by operating on a number of similarly difficult cases. However, even in large population centers, there are extremely rare cases, such as craniopagus twins. In these instances, other case-specific solutions are required which were improved in the course of fresh cadaver practice on daily base. Methods: During a 20-month preparation period by fresh cadavers the surgical strategy was developed step by step, comprising five neurosurgical ideas, facilitated by deep Jesus prayers as a spiritual source. Possible causes of postoperative complications that occured on 33d postoperative day were also analyzed. Results: During surgery, these nuances proved to be useful, which is also reflected by the postoperative clinical results. One of the twins advanced to a GOS score of 5three months after the surgery. The other twin, despite nonsurgical septic complications, continued to progress well, but on postoperative day 33 for seemingly unknown reasons, she suffered a severe cerebral hemorrhage, which significantly delayed her rehabilitation. A thorough revision of the whole process much later revealed a pitfall that could have a role in this complication. Conclusions: The challenging neurosurgical separation of the craniopagus twins was carried out successfully with the help of five novel neurosurgical refinements, which were found during 300 fresh cadaver practices. Mistakes can serve as a lesson. We hope that the procedures developed and the knowledge gained can be applied in the future.展开更多
文摘Background: The difficulty of learning curve in different microsurgical regions is one of the most challenging factors that affect neurosurgeon’s life. Two of the delicate areas are the suprasellar intraventricular and pontocerebellar region. High level of microsurgery or endoscopic surgery requires virtuosity, which can not be learnt only by assisting. Even among the well skilled neurosurgeons who work in big centers we can often hear “in spite of centralization there are not enough operations available to keep the high level of our skills”. The situation of surgeons working at mid centers is more difficult especially on duties. Methods: Huge number of scientific articles demonstrate the importance of different types of cadaver practice, but always did not pay enough attention to the daily fast fresh cadaver exercises. Focusing on lifelong every day practice we examined the difficulties of learning curve in intraventricular and pontocerebellar region and try to give some useful advice for practicing on fresh cadavers on a daily basis. We offer a simple endovascular fresh cadaver model for practicing. Results: We have performed more than 800 quick (60 - 90 minutes long) routine practice sessions in these two regions during last 18 years. We found that implantation a modelized pathology and removing it by microscopical or endoscopic way without causing injuries to sensitive structures seems to be the most practical way of fast everyday training. Nerves and vascular bypass sutures are also excellent practical method. Conclusions: We have focused on daily fast fresh cadaver practice as a novel training method like used in professional sport and art. After 18 years experience we can state that, for mastering the microsurgery of pontocerebellar and intraventricular region, which is one of the most challenging regions minimum 100 fresh cadaver practice sessions need before performing the operation. We believe this region should be part of fast fresh cadaver microsurgical practice routine programme on daily bases, minimum one time/week/person.
文摘Purpose: Challenging cases in neurosurgery require experience, which is gained by operating on a number of similarly difficult cases. However, even in large population centers, there are extremely rare cases, such as craniopagus twins. In these instances, other case-specific solutions are required which were improved in the course of fresh cadaver practice on daily base. Methods: During a 20-month preparation period by fresh cadavers the surgical strategy was developed step by step, comprising five neurosurgical ideas, facilitated by deep Jesus prayers as a spiritual source. Possible causes of postoperative complications that occured on 33d postoperative day were also analyzed. Results: During surgery, these nuances proved to be useful, which is also reflected by the postoperative clinical results. One of the twins advanced to a GOS score of 5three months after the surgery. The other twin, despite nonsurgical septic complications, continued to progress well, but on postoperative day 33 for seemingly unknown reasons, she suffered a severe cerebral hemorrhage, which significantly delayed her rehabilitation. A thorough revision of the whole process much later revealed a pitfall that could have a role in this complication. Conclusions: The challenging neurosurgical separation of the craniopagus twins was carried out successfully with the help of five novel neurosurgical refinements, which were found during 300 fresh cadaver practices. Mistakes can serve as a lesson. We hope that the procedures developed and the knowledge gained can be applied in the future.
