Simulation Training in Neurosurgery : Development and Evaluation of a Practical Training Simulator for the Microsurgical Management of Middle Cerebral Artery Aneurysms

Abstract

Neurosurgery demands significant expertise and technical skills, traditionally acquired through training in operative settings. The introduction of alternative treatment options as well as socioeconomic changes over the past two decades, however, have led to a significant decline in surgical caseload, limiting training opportunities for young neurosurgeons to develop and refine their skills. This shift is perhaps nowhere more impactful than in the field of vascular neurosurgery, where the emergence of endovascular treatment options has led to a continuous decline in microsurgically managed aneurysm cases. Despite this trend, the surgical management often remains the superior treatment method, particularly in middle cerebral artery aneurysms, underscoring the importance of training opportunities to maintain surgical expertise. Synthetic simulators have the potental for targeted, hands-on training in a controlled environment. Yet, the incorporation of such simulators into the neurosurgical curriculum remains a challenge due to their lack of realism, limited usability and high acquisition costs. This work aims to address these challenges by developing a novel practical, cost-effective, easily reproducible yet highly realistic simulator for the microneurosurgical clipping of middle cerebral artery aneurysms employing additive manufacturing, rheological analyses, and neurosurgical expertise. Tested by 12 participants across different neurosurgery experience levels, the simulator demonstrated high face and content validities across all categories, derived from a 5-Point Likert scale with a mean score of 4,9/5. Objective assessments of surgical performances revealed that the simulator accurately reflects the skills of the participants, signaling a high construct validity. The efficacy of the simulator was showcased by a rapid and significant acceleration in surgical prescision and quality, paticularly among novice medical students and neurosurgical residents.