Pilot Validation of a 3-Dimensional Printed Pituitary Adenoma, Vascular Injury, and Cerebrospinal Fluid Leak Surgical Simulator

Oper Neurosurg (Hagerstown). 2024 Nov 1;27(5):632-640. doi: 10.1227/ons.0000000000001177. Epub 2024 May 21.

Abstract

Background and objectives: Endoscopic skull base surgery is a subspecialty field which would benefit significantly from high-fidelity surgical simulators. Giving trainees the opportunity to flatten their learning curve by practicing a variety of procedures on surgical simulators will inevitably improve patient outcomes.

Methods: Four neurosurgeons, 8 otolarynologists, and 6 expert course faculty agreed to participate. All participants were asked to perform a transsphenoidal exposure and resection of a pituitary adenoma, repair a cerebrospinal fluid (CSF) leak, control a carotid injury, and repair a skull base defect. The content, face, and construct validity of the 3-dimensional printed model was examined.

Results: The heart rate of the participants significantly increased from baseline when starting the carotid injury simulation (mean 90 vs 121, P = .029) and significantly decreased once the injury was controlled (mean 121 vs 110, P = .033, respectively). The participants reported a significant improvement in anxiety in facing a major vascular injury, as well as an increase in their confidence in management of major vascular injury, resecting a pituitary adenoma and repair of a CSF leak using a 5-point Likert scale (mean 4.42 vs 3.58 P = .05, 2 vs 3.25 P < .001, 2.36 vs 4.27 P < .001 and 2.45 vs 4.0 P = .001, respectively). The mean Objective Structured Assessment of Technical Skills score for experienced stations was 4.4, significantly higher than the Objective Structured Assessment of Technical Skills score for inexperienced stations (mean 3.65, P = .016).

Conclusion: We have demonstrated for the first time a validated 3-dimensional printed surgical simulator for endoscopic pituitary surgery that allows surgeons to practice a transsphenoidal approach, surgical resection of a pituitary adenoma, repair of a CSF leak in the diaphragma sellae, control of a carotid injury, and repair of skull base defect.

Publication types

  • Validation Study

MeSH terms

  • Adenoma* / surgery
  • Carotid Artery Injuries / etiology
  • Carotid Artery Injuries / surgery
  • Cerebrospinal Fluid Leak* / etiology
  • Clinical Competence
  • Humans
  • Models, Anatomic
  • Neuroendoscopy / education
  • Neuroendoscopy / methods
  • Neurosurgeons / education
  • Neurosurgical Procedures / education
  • Neurosurgical Procedures / methods
  • Pilot Projects
  • Pituitary Neoplasms* / surgery
  • Printing, Three-Dimensional*
  • Simulation Training / methods
  • Skull Base / surgery
  • Vascular System Injuries / etiology
  • Vascular System Injuries / surgery