Quality Assurance During Brain Aneurysm Microsurgery—Operative Error Teaching

Training Cerebrovascular and Neuroendovascular Surgery Residents: A Systematic Literature Review and Recommendations

“…The first category of studies (29.2%, 14/48) includes studies evaluating trainee education and competency (Table 1). 4,5,[11][12][13][14][15][16][17][18][19][20][21][22] These studies queried the perceived abil-ity, experience, and clinical knowledge of participants relevant to cerebrovascular disease through either subjective assessments or questionnaires (57.1%, 8/14), 4,5,[17][18][19][20][21][22] review of case logs (21.4%, 3/14), [14][15][16] or direct evaluation in cases or using models (21.4%, 3/14). [11][12][13] Reports reviewing case logs unanimously described decreases in open cerebrovascular volume and increases in endovascular volume during residency, [14][15][16] with the endovascular field seeing increased enrollment in postgraduate fellowship.…”

“…4,5 All reports assessing alternative practical training methods outside of the operating room reported positive results with a range of models, simulations, didactics, and direct feedback. [11][12][13][17][18][19][20][21][22] The second category of studies (20.8%, 10/48) includes studies describing neuroendovascular training models (Table 2). 6,8,[23][24][25][26][27][28][29][30] The studies described experiences using commercially available simulation systems (60.0%, 6/10), 6,8,[23][24][25][26] synthetic constructs (30.0%, 3/10), [27][28][29] and a live animal model (10%, 1/10) 30 in technical training and case preparation for diagnostic and interventional procedures.…”

“…Multiple studies have investigated trainee proficiency in the endovascular and microsurgical fields through surveys, case logs, and subjective assessments. 4,5,[11][12][13][14][15][16][17][18][19][20][21][22] Case log assessments highlighted the inverse relationship of rising endovascular and decreasing open volumes. [14][15][16] Multiple reports suggested that the decrease in open cases was adequately supplemented with simulated training models.…”

“…[14][15][16] Multiple reports suggested that the decrease in open cases was adequately supplemented with simulated training models. 11,12,[18][19][20]22 However, open cerebrovascular surgery is technically complex, requiring significant repetition and frequent exposure. [64][65][66][67][68] Complex cases such as basilar apex aneurysms or high-flow anastomoses may be exceedingly rare in many programs.…”

“…71 Given decreased open case volumes, many reports describe positive resident feedback and technical improvements following completion of didactics and skilled tasks in a laboratory setting. 11,12,15,19,22 Neuroendovascular fellowship training has seen a rise in fellowship enrollment and case volume. 4,5,14,17,21 Reviewed assessments indicate that fellowship training was most often pursued because of a lack of exposure during residency.…”