Simulation Training in Neurological Surgery

Review Article

Austin Neurosurg Open Access. 2014;1(1): 1004.

Simulation Training in Neurological Surgery

Paramita Das, Tarini Goyal, Andrew Xue, Sruti Kalatoor and Daniel Guillaume*

Department of Neurosurgery, University of Minnesota, USA

*Corresponding author: Daniel Guillaume, Department of Neurosurgery, University of Minnesota, D429 Mayo Memorial Building, 420 delaware Street S.E. MMC96, Minneapoilis, MN 55455, USA

Received: March 18, 2014; Accepted: April 18, 2014; Published: April 21, 2014


In medicine there is an increasing emphasis on efficiency, error reduction, and training within limited hours. Simulation training has played a role in neurosurgical training. With improvements in haptic technology and visual displays, virtual reality surgical simulators can offer a tool for surgical planning, and training in a safe environment. In this review we discuss the current state of medical simulation, the integration of simulation into current neurosurgical residency training, specific neurosurgical simulation experiences, the potential benefit of simulation and the future of neurosurgical simulation.

Keywords: Neurosurgical Simulation; Endoscopic; Hemostasis


Our primary objective in neurosurgery is to provide high–quality patient care that is safe and effective. Over the course of our careers, we strive to achieve excellence in all aspects of the care we provide. When it comes to educating future neurosurgeons, our goal is to provide them with the knowledge and technical skills needed so they can go on to provide safe high–quality care to their patients.

Surgical training has evolved over the last several decades and surgical simulation continues to play a growing role. Three major forces driving neurosurgical simulation development are: regulations in surgical resident training, higher demands for quality and safety, and higher expectations from patients and families.

The first factor leading to use of surgical simulation in resident training has been recent changes in resident educational regulations, the greatest being the 80–hour per week resident work hour limit instituted from the Accreditation Council for Graduate Medical Education. Because residents must now spend less time in the hospital while obtaining their education in the same number of years, training programs need to be more efficient in methods of educating and teaching surgical dexterity to residents. Additionally, there is a need for objective measurements of competence. With advances in surgical simulation technology, the potential exists for a means to collect data that may be useful in measuring surgical technical ability.

A second driving force promoting simulation training is a desire from health–care facilities and payers to improve the quality and safety of our specialty. Because simulation can allow acquisition and refinement of surgical techniques in an educational environment free from the pressures, demands and risks of patient care, there is an opportunity for residents to acquire and perfect technical skills prior to operating on an actual patient.

A third issue leading to an increasing role of simulation in resident education has occurred as patients and families have developed a higher expectation from physicians and a lower tolerance of complications. Patients will want to know if their neurosurgeon is competent and experienced. Hospitals expect greater efficiency in the operating room. There is a growing expectation that surgical simulation is a part of neurosurgical training, just as flight simulation is part of a pilot’s training.

In the future, we expect simulation to play an increasingly large role in education and training of neurosurgical residents. The value of simulation will increase as technology improves, and as simulators can more closely mimic a true surgical field. Work in education and simulation research will need to focus on validation studies that carefully evaluate the usefulness of simulation as a tool that actually improves our ability to operate.

In addition to resident education, neurosurgical simulation has developed a role in continuing education and in pre–surgical planning. For planning of operations on specific patients, imaging data can be loaded onto a variety of simulation devices including even the Apple IPad, for anatomic study and planning. Other potential roles exist in anatomic study, surgical rehearsal of uncommon procedures, and credentialing.

In this review we discuss the current state of medical simulation, the integration of simulation into current neurosurgical residency training, specific neurosurgical simulation experiences, the potential benefit of simulation and the future of neurosurgical simulation.

Types of Simulation in Neurosurgery

Simulation in medical education is not a new concept, and in fact cadaveric dissection as a form of surgical simulation has been used as a primary means of education for hundreds of years. The earliest non cadaver and non animal models in medical training started in the 1950s when mannequins were introduced into medical training to simulate basic cardiopulmonary resuscitation [1]. Likewise, throughout history a primary means of medical education has been in scenario simulation, where the trainee is asked to think through and describe all of the steps in order of an activity such as management of the patient with intracranial hypertension, or the surgical steps needed for clipping a posterior communicating artery aneurysm. This has been the basis for the oral board exam in our specialty. Surgical simulators, which are designed to evaluate technical ability of the trainee, are relatively new and currently in the early stages of development.

Simulation is presently used in many different ways in the education of neurosurgical trainees. Photographic rendering, virtual interaction, anatomic models and haptic devices are the core components of today’s simulators [2]. Haptics refers to the feedbackof sensory information. It is an integration of what is seen with a realistic sensation of what is felt [3]. Medical educational simulators are generally described as being one of 4 basic types: physical, virtual reality (VR), web–based and hybrids (Table 1). The majority of those used in neurosurgical simulation to date are of the physical and virtual reality type.

Citation: Das P, Goyal T, Xue A, Kalatoor S, Guillaume D. Simulation Training in Neurological Surgery. Austin Neurosurg Open Access. 2014;1(1): 1004.