Key role of microsurgical dissections on cadaveric specimens in neurosurgical training: Setting up a new research anatomical laboratory and defining neuroanatomical milestones

Abstract

Introduction: Neurosurgery is one of the most complex surgical disciplines where psychomotor skills and deep anatomical and neurological knowledge find their maximum expression. A long period of preparation is necessary to acquire a solid theoretical background and technical skills, improve manual dexterity and visuospatial ability, and try and refine surgical techniques. Moreover, both studying and surgical practice are necessary to deeply understand neuroanatomy, the relationships between structures, and the three-dimensional (3D) orientation that is the core of neurosurgeons' preparation. For all these reasons, a microsurgical neuroanatomy laboratory with human cadaveric specimens results in a unique and irreplaceable training tool that allows the reproduction of patients' positions, 3D anatomy, tissues' consistencies, and step-by-step surgical procedures almost identical to the real ones.

Methods: We describe our experience in setting up a new microsurgical neuroanatomy lab (IRCCS Neuromed, Pozzilli, Italy), focusing on the development of training activity programs and microsurgical milestones useful to train the next generation of surgeons. All the required materials and instruments were listed.

Results: Six competency levels were designed according to the year of residency, with training exercises and procedures defined for each competency level: (1) soft tissue dissections, bone drilling, and microsurgical suturing; (2) basic craniotomies and neurovascular anatomy; (3) white matter dissection; (4) skull base transcranial approaches; (5) endoscopic approaches; and (6) microanastomosis. A checklist with the milestones was provided.

Discussion: Microsurgical dissection of human cadaveric specimens is the optimal way to learn and train on neuroanatomy and neurosurgical procedures before performing them safely in the operating room. We provided a "neurosurgery booklet" with progressive milestones for neurosurgical residents. This step-by-step program may improve the quality of training and guarantee equal skill acquisition across countries. We believe that more efforts should be made to create new microsurgical laboratories, popularize the importance of body donation, and establish a network between universities and laboratories to introduce a compulsory operative training program.

Keywords: anatomical dissection; anatomy laboratory; cadaveric specimen; microanastomosis; neurosurgical training; skull base technique.

Figure 1

Workstations at “Laboratorio di neuroanatomia G. Cantore.”

Figure 2

Arrangement of the stations during our (A) microsurgical and (B) endoscopic courses.

Figure 3

Workstation for microanastomosis on (A) inert materials and (B) wet specimens.

Figure 4

(A) Preparation of human placenta for microanastomosis with cannulation of the umbilical arteries and vein. After washing arteries and veins with clean water to remove blood clots, colored saline solution is used to continuously fill the vessels mimicking the blood. (B) Vascular dissection and microanastomosis on human placenta using a 3D exoscope.

Figure 5

(A,B) Workstation to perform dissection and microanastomosis on in vivo rats.