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Arnau Benet, Jordina Rincon-Torroella, Michael T. Lawton, and J. J. González Sánchez

N eurosurgery is one of the most challenging surgical specialties because it deals with the most complex and fragile organ in the human body—the brain—and because it requires a combination of precise technical skills, experience in the surgical setting, and superb knowledge of anatomy. Surgical simulation using a cadaveric human head is one of the most valid strategies for neurosurgical research and training because it provides the closest approximation to a live surgical procedure with true human anatomy. Several models for neurosurgical training have

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Matthew A. Kirkman, Maria Ahmed, Angelique F. Albert, Mark H. Wilson, Dipankar Nandi, and Nick Sevdalis

the effect of resident duty-hour restrictions as stipulated by the Accreditation Council for Graduate Medical Education (ACGME) is an increase in adverse patient outcomes. 17 As such, working-hour restrictions necessitate the delivery of high-quality, time-effective training to surgeons to ensure optimal patient outcomes. Simulation has been postulated as a potential solution to the challenge of providing appropriate training in less time 21 , 50 and represents a useful proxy measure for expert surgical performance. Simulation as a concept is diverse and can

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Brendan Santyr, Mohamad Abbass, Alan Chalil, Amirti Vivekanandan, Daria Krivosheya, Lynn M. Denning, Thomas K. Mattingly, Faizal A. Haji, and Stephen P. Lownie

volumes to gain enough exposure to achieve competence. 2 , 3 Advances in alternative therapies and minimally invasive techniques have had an impact on surgical training volumes. Neurosurgical vascular case volumes in particular have decreased because of the increased number of endovascular options. 4 Gaining mastery in microsurgical skills requires regular practice and cannot be achieved by observation alone. 5 As fewer microvascular cases are performed regularly in neurosurgery, educators are looking toward simulation to supplement operative exposure. 6 , 7 There

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Daniel R. Cleary, Dominic A. Siler, Nathaniel Whitney, and Nathan R. Selden

without experience or direct support. In 2009, postgraduate year 1 (PGY1) neurological surgery residents attended a Society of Neurological Surgeons (SNS) pilot “boot camp” course designed in part to enhance their familiarity with and safety performing neurosurgical procedures and basic operative skills prior to practicing them in the live clinical environment. 24 , 25 Simulation training early in residency is effective in improving residents’ confidence in and proficiency with basic technical skills, as well as knowledge retention. 3 , 9 , 23 Neurosurgery program

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Steven Knafo, Nicolas Penet, Stephan Gaillard, and Fabrice Parker

W ith the advent of simulation training, two different aspects of medical practice are increasingly recognized: “technical skills,” relating to the manual execution of a given procedure, and “nontechnical skills,” referring to the interpersonal relationships occurring around this procedure. Simulation has been widely studied in a variety of acute care settings (including surgery and the ICU) to assess interpersonal skills, 1 and many studies have demonstrated that simulation could improve communication, teamwork, and, eventually, patient outcomes in the

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Sean Sullivan, Pedro Aguilar-Salinas, Roberta Santos, Alexandra D. Beier, and Ricardo A. Hanel

F or many years simulation has been used in a variety of fields, from aviation to general surgery, as a training tool to gain technical skills through repetition while also rehearsing procedures in a safe environment. 12 , 17 The use of simulation in neurointervention to acquire and enhance skills before treating a patient is more recent, but the lack of good models and deficient haptics have limited its utilization. The advent of 3D printing technology and the development of new training models have modified this landscape. The use of simulation in

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Jesse L. Winer, Daniel R. Kramer, Richard A. Robison, Ifije Ohiorhenuan, Michael Minneti, Steven Giannotta, and Gabriel Zada

to operative cases throughout the training process may be a progressively limiting factor in education. For these reasons, surgical simulation in 3D virtual reality and live-tissue models for trainee education has garnered considerable popularity in recent years. 9 , 11 , 12 , 14 The ability to rehearse skills required to perform key steps in an operative procedure before performing live surgery, acquire basic familiarity with equipment and surgical approaches, and build the psychosomatic foundations required to perform a given operation may improve surgical

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Evgenii Belykh, Irakliy Abramov, Liudmila Bardonova, Ruchi Patel, Sarah McBryan, Lara Enriquez Bouza, Neil Majmundar, Xiaochun Zhao, Vadim A. Byvaltsev, Stephen A. Johnson, Amit Singla, Gaurav Gupta, Hai Sun, James K. Liu, Anil Nanda, Mark C. Preul, and Michael T. Lawton

soft tissues, such as a myocutaneous flap. To avoid the aforementioned limitations, we devised a set of new simulation models for convenient, quick, and repetitive dry microneurosurgical training. We created 7 simulation scenarios to match specific cases of bypass surgeries within pertinent anatomically different locations for microanastomosis performed by the senior author (M.T.L.). The goal of this study was to describe these models and to assess their face and content validity. Methods Methodology and Institutional Approval This study was approved by

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Ravi Sharma, Varidh Katiyar, Priya Narwal, Shashank S. Kale, and Ashish Suri

responsibility in the OR. It has long been acknowledged that the best method of acquiring technical finesse and sound surgical acumen is by performing the procedure under watchful guidance. The longer learning curve in neurosurgery as well as the higher stakes of the most minuscule errors makes the traditional implementation of the Halsted model inefficient. 1 – 4 Hence, nontraditional, or "out of OR" simulation-based training, is essential for neurosurgery. 5 – 7 Currently, this need is higher due to multiple factors such as an increase in the number of residents, work hour

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Daniel A. Donoho, Dhiraj J. Pangal, Guillaume Kugener, Martin Rutkowski, Alexander Micko, Shane Shahrestani, Andrew Brunswick, Michael Minneti, Bozena B. Wrobel, and Gabriel Zada

experience. 4 , 5 When technical skill cannot be learned during standard surgical education, surgeons often turn to simulation. 6 Most technical skill simulations train for complex, high-fidelity rehearsals or routine scenarios where minimum performance can be improved using low-cost materials. 8 Simulation for surgeons to achieve mastery of rare, life-threatening complications does not fit the context of many routine simulation scenarios. During the creation of our departmental simulation curriculum, 9 we recognized the importance of specific training to manage ICAI