Design and validation of a hemispherectomy simulator for neurosurgical education

Grace M. Thiong’o MD1,2, Thomas Looi PhD1, James T. Rutka MD, PhD, FRCSC2, Abhaya V. Kulkarni MD, PhD, FRCSC2, and James M. Drake MBBCh1,2
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  • 1 The Hospital for Sick Children, Posluns Center for Image Guided Innovation and Therapeutic Intervention; and
  • | 2 Department of Surgery, University of Toronto, Ontario, Canada
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OBJECTIVE

Early adaptors of surgical simulation have documented a translation to improved intraoperative surgical performance. Similar progress would boost neurosurgical education, especially in highly nuanced epilepsy surgeries. This study introduces a hands-on cerebral hemispheric surgery simulator and evaluates its usefulness in teaching epilepsy surgeries.

METHODS

Initially, the anatomical realism of the simulator and its perceived effectiveness as a training tool were evaluated by two epilepsy neurosurgeons. The surgeons independently simulated hemispherotomy procedures and provided questionnaire feedback. Both surgeons agreed on the anatomical realism and effectiveness of this training tool. Next, construct validity was evaluated by modeling the proficiency (task-completion time) of 13 participants, who spanned the experience range from novice to expert.

RESULTS

Poisson regression yielded a significant whole-model fit (χ2 = 30.11, p < 0.0001). The association between proficiency when using the training tool and the combined effect of prior exposure to hemispherotomy surgery and career span was statistically significant (χ2 = 7.30, p = 0.007); in isolation, pre-simulation exposure to hemispherotomy surgery (χ2 = 6.71, p = 0.009) and career length (χ2 = 14.21, p < 0.001) were also significant. The mean (± SD) task-completion time was 25.59 ± 9.75 minutes. Plotting career length against task-completion time provided insights on learning curves of epilepsy surgery. Prediction formulae estimated that 10 real-life hemispherotomy cases would be needed to approach the proficiency seen in experts.

CONCLUSIONS

The cerebral hemispheric surgery simulator is a reasonable epilepsy surgery training tool in the quest to increase preoperative practice opportunities for neurosurgical education.

ABBREVIATIONS

DRE = drug-resistant epilepsy; FDM = fused deposition modeling; GLZM = generalized linear model; MCA = middle cerebral artery; OSATS = Objective Structured Assessment of Technical Skills; PGY = postgraduate year; STL = Standard Tessellation Language.

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