Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 19;46(1):248.
doi: 10.1007/s10143-023-02149-3.

Training models and simulators for endoscopic transsphenoidal surgery: a systematic review

Giacomo Santona  1 , Alba Madoglio  2   3 , Davide Mattavelli  4 , Mario Rigante  5 , Marco Ferrari  6 , Liverana Lauretti  7   8 , Pierpaolo Mattogno  8 , Claudio Parrilla  5 , Pasquale De Bonis  2   3 , Jacopo Galli  5   9 , Alessandro Olivi  7   8 , Marco Maria Fontanella  10 , Antonio Fiorentino  11 , Mauro Serpelloni  1 , Francesco Doglietto  12   13
Affiliations

Training models and simulators for endoscopic transsphenoidal surgery: a systematic review

Giacomo Santona et al. Neurosurg Rev. .

Abstract

Endoscopic transsphenoidal surgery is a novel surgical technique requiring specific training. Different models and simulators have been recently suggested for it, but no systematic review is available. To provide a systematic and critical literature review and up-to-date description of the training models or simulators dedicated to endoscopic transsphenoidal surgery. A search was performed on PubMed and Scopus databases for articles published until February 2023; Google was also searched to document commercially available. For each model, the following features were recorded: training performed, tumor/arachnoid reproduction, assessment and validation, and cost. Of the 1199 retrieved articles, 101 were included in the final analysis. The described models can be subdivided into 5 major categories: (1) enhanced cadaveric heads; (2) animal models; (3) training artificial solutions, with increasing complexity (from "box-trainers" to multi-material, ct-based models); (4) training simulators, based on virtual or augmented reality; (5) Pre-operative planning models and simulators. Each available training model has specific advantages and limitations. Costs are high for cadaver-based solutions and vary significantly for the other solutions. Cheaper solutions seem useful only for the first stages of training. Most models do not provide a simulation of the sellar tumor, and a realistic simulation of the suprasellar arachnoid. Most artificial models do not provide a realistic and cost-efficient simulation of the most delicate and relatively common phase of surgery, i.e., tumor removal with arachnoid preservation; current research should optimize this to train future neurosurgical generations efficiently and safely.

Keywords: 3D printing; Animal head; Arachnoid; Cadaveric head; Pituitary adenoma; Training models; Training simulators; Transsphenoidal surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Training models and simulators diagram
Fig. 2
Fig. 2
PRISMA 2020 flow chart
See this image and copyright information in PMC

References

    1. Doglietto F, Prevedello DM, Jane JA, Han J, Laws ER. Brief history of endoscopic transsphenoidal surgery--from Philipp Bozzini to the First World Congress of Endoscopic Skull Base Surgery. Neurosurg Focus. 2005;19:E3. doi: 10.3171/foc.2005.19.6.4. - DOI - PubMed
    1. Agosti E, Saraceno G, Qiu J, Buffoli B, Ferrari M, Raffetti E, Belotti F, Ravanelli M, Mattavelli D, Schreiber A, Hirtler L, Rodella LF, Maroldi R, Nicolai P, Gentili F, Kucharczyk W, Fontanella MM, Doglietto F. Quantitative anatomical comparison of transnasal and transcranial approaches to the clivus. Acta Neurochir (Wien) 2020;162:649–660. doi: 10.1007/s00701-019-04152-4. - DOI - PubMed
    1. Belotti F, Doglietto F, Schreiber A, Ravanelli M, Ferrari M, Lancini D, Rampinelli V, Hirtler L, Buffoli B, Bolzoni Villaret A, Maroldi R, Rodella LF, Nicolai P, Fontanella MM. Modular classification of endoscopic endonasal transsphenoidal approaches to sellar region: anatomic quantitative study. World Neurosurg. 2018;109:e281–e291. doi: 10.1016/j.wneu.2017.09.165. - DOI - PubMed
    1. Doglietto F, Ferrari M, Mattavelli D, Belotti F, Rampinelli V, Kheshaifati H, Lancini D, Schreiber A, Sorrentino T, Ravanelli M, Buffoli B, Hirtler L, Maroldi R, Nicolai P, Rodella LF, Fontanella MM. Transnasal endoscopic and lateral approaches to the clivus: a quantitative anatomic study. World Neurosurg. 2018;113:e659–e671. doi: 10.1016/j.wneu.2018.02.118. - DOI - PubMed
    1. Schreiber A, Ferrari M, Rampinelli V, Doglietto F, Belotti F, Lancini D, Ravanelli M, Rodella LF, Fontanella MM, Nicolai P. Modular endoscopic medial maxillectomies: quantitative analysis of surgical exposure in a preclinical setting. World Neurosurg. 2017;100:44–55. doi: 10.1016/j.wneu.2016.12.094. - DOI - PubMed

Publication types