Using walnut shell in the microdrilling training model

Abstract

IntroductionMicrosurgical drilling of thin and delicate bones is a specific part of microneurosurgery. The neuroanatomical location of cranial base structures including basal cerebral arteries, hypophysis, cranial nerves, and brain stem makes the surgical approach to the cranial base unique in microneurosurgery [1][2][3][4][5]. Specific microneurosurgical techniques should be repetitively trained in laboratory on the appropriate models. Proper using of the operative microscope, holding, and grasping of the microneurosurgical instruments, proper microsurgical technique of the opening of the arachnoid membranes, The modeling of the surgical steps with creating a suitable laboratory models is critically important issue in the successful gaining of microneurosurgical practice. In this experimental study, a laboratory-training model was created for microneurosurgical drilling of delicate and thin cranial base bones using walnut shell in the repetitive repeating of experimental microsurgical training technique. Materials and Methods: All steps of this study were performed under the operating microscope. Twenty-five walnut shells were used for this experimental feasibility study. The difficulty and suitability of the model were evaluated in terms of the usability in the training of microneurosurgical microdrilling. Difficulty of the procedure was divided into three degrees (very easy, easy, and difficult). The objective criterion for the evaluation of the difficulty of the procedure was the protection of the interior organic material during the procedure. The suitability of the procedure was also evaluated within three groups, bad, good, and perfect. Results: In three (12%) walnut shells, the microdrilling was evaluated as difficult. The microdrilling procedures of the twelve (48%) walnut shells were evaluated as easy procedure. Microdrilling procedure of the remaining ten (40%) of the walnut shells was evaluated as very easy. The suitability of the model was evaluated as bad in two (8%) of the walnut shells. The suitability was found as good in 17 (68%) of the walnut shells. In microdrilling of the remaining six (24%) of the walnut shells, the suitability of the model was evaluated as perfect. Conclusion: Microsurgical drilling of the walnut shells without any interior organic injury is accepted as the indication of the successful surgical microdrilling process. Consolidation of the surgical practice in a laboratory setting, grasping, and using of microsurgical instruments can be repeated several times in this model. We believe that this model will contribute to the practical training of microneurosurgery.