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Grace M. Thiong’o, Thomas Looi, James T. Rutka, Abhaya V. Kulkarni, and James M. Drake


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.


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.


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.


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

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Anthony L. Asher, Sally El Sammak, Giorgos D. Michalopoulos, Yagiz U. Yolcu, A. Yohan Alexander, John J. Knightly, Kevin T. Foley, Christopher I. Shaffrey, Robert E. Harbaugh, Geoffrey A. Rose, Domagoj Coric, Erica F. Bisson, Steven D. Glassman, Praveen V. Mummaneni, and Mohamad Bydon

-sectionality. For example, the focus of ACS NSQIP is considered perioperative and hence only captures 30-day outcomes, which can hinder procedural analyses. 27 While these data sets and several others available via claims data, financial data, and private databases (e.g., MarketScan Research Database and PearlDriver) were not specific for the field of neurosurgery, the need to oblige to the momentum of “big data” research took priority. However, the information within these databases might not always have been sufficient to analyze neurosurgical trends and outcomes of operations

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Masahiko Kitano, Mamoru Taneda, Taro Shimono, and Yuzo Nakao

limitations of this approach are the narrow and deep operating field, which pose the risk of ICA injury during blind procedures when the lateral sellar region is not adequately exposed. In recent neurosurgical trends, endoscopic procedures have gained popularity in transsphenoidal operations because a side-viewing endoscope affords a more panoramic view than the operating microscope. 1 , 7 , 9 , 25 Frank and Pasquini 18 have reported that the increased visualization given by the endoscope permitted the demonstration of minor tumoral extensions through small focal