Microneurosurgical Skills Training

Abstract

Microneurosurgical operations differ from other surgery. Longer operative time, narrow and deep-seated operative corridors, hand-eye coordination, fine manipulation, and physiologic tremor present special problems. Proper understanding of visual feedback, control of physiologic tremor, better instrument design, and development of surgical skills with better precision is important for optimal surgical results. Using the pen-type precision grip with well-supported arm, wrist, hand, and fingers avoids fatigue and improves precision. Proper instrument design, patient positioning, hemostasis techniques, tilting operative table, good operative microscope, an adjustable chair, careful use of suction tube, bipolar forceps, and brain retraction play important roles in microneurosurgery. Sufficient clinical case volume or opportunity during routine operative hours may not be available in the beginning for young neurosurgeons; microsurgical training using various models can enable them to gain experience. Training models using deep-seated and narrow operative corridors, drilling, knot-tying technique, and anastomosis using fine sutures under high magnification can be practiced for skill improvement. Training laboratory and simulation modules can be useful for resident training and skill acquisition. Indigenously made inexpensive models and comparatively less expensive microscopes can be used in resource-constrained situations. The maintenance of microsurgical ability should be preserved by staying active in operative practice. The knowledge of ergonomics, proper training, observing hand movements of skillful surgeons, and the use of operative videos can improve skill. Endoscopic assistance, computer-assisted robot hand technique, and microtechnology can provide access to the smallest areas of the body.

Learning Microvascular Anastomosis in Low Socioeconomic Vascular Models During Residency

“…The hand grip is a very important factor for proper instrument handling. It can be classified as power and precision grip [8]. The most commonly used is pen grip with greater stability.…”

“…The quiet hand technique is performed by the thumb and I, II, III fingertips. Each muscle contraction adds tiredness and predisposes to tremor [8-10]. Any kind of fixed support can be placed close to the operative site for hand support.…”

Using of the chicken wing's bone in the microneusurgical training model for microdrilling

“…Training of microneurosurgery including microdrilling of the bone using high-speed drill is extremely important in the microsurgery practice. [ 1 2 3 ] Theoretical and practical training of microneurosurgery includes many difficult, time and ability requiring steps in neurosurgical period of life. [ 1 2 3 ] Specific microneurosurgical techniques such as properly using of the operative microscope, holding and grasping of the microneurosurgical instruments, proper microsurgical technique of the opening of the arachnoid membranes, safe and delicate neurovascular dissection, and carefully and properly microdrilling of the cranial base bones should be learnt before taking place in front of the patient's head in the operating room.…”

“…[ 1 2 3 ] Theoretical and practical training of microneurosurgery includes many difficult, time and ability requiring steps in neurosurgical period of life. [ 1 2 3 ] Specific microneurosurgical techniques such as properly using of the operative microscope, holding and grasping of the microneurosurgical instruments, proper microsurgical technique of the opening of the arachnoid membranes, safe and delicate neurovascular dissection, and carefully and properly microdrilling of the cranial base bones should be learnt before taking place in front of the patient's head in the operating room. [ 1 4 5 6 7 8 ] Spending of time in experimental microsurgical laboratory to practice some kind of microsurgical models, such as dissection and suturing of the rat external carotid artery, dissection and evaluation of the abdominal vena cava of rats, suturing of the plastic glove materials by using micro forceps under the operating microscope, and drilling and dissection of some cadaveric bone materials, are essential improving and gaining of advanced microneurosurgical practical techniques.…”

“…[ 1 4 5 6 7 8 ] Spending of time in experimental microsurgical laboratory to practice some kind of microsurgical models, such as dissection and suturing of the rat external carotid artery, dissection and evaluation of the abdominal vena cava of rats, suturing of the plastic glove materials by using micro forceps under the operating microscope, and drilling and dissection of some cadaveric bone materials, are essential improving and gaining of advanced microneurosurgical practical techniques. [ 1 3 4 5 6 7 8 ]…”