Development and Assessment of a High-Fidelity Simulator for the Microsurgical Dissection of the Sylvian Fissure.

Abstract

The dissection of the Sylvian fissure (SF) is a crucial technique requiring considerable expertise and skills traditionally acquired through years of experience. The continuous decline in surgical case-load necessitates the development of efficient alternative training opportunities. However, building a realistic and effective training simulator for the microsurgical dissection of the SF as an integral part of the neurosurgical curriculum remains a challenging endeavor. This work aims to develop and evaluate a high-fidelity phantom simulator for effective and transferable training of the SF dissection with a focus on middle cerebral artery aneurysm clipping. A phantom simulator replicating the anatomy and tactile properties of the human skull, brain, and meninges was developed that incorporates additive manufacturing, neurosurgical expertise, and tissue engineering. Neurosurgical residents and experienced vascular neurosurgeons (n = 16) tested and rated the simulator's face and content validities and answered questions on the model's educational usefulness. The resulting SF model was found to be anatomically and haptically faithful, reusable, and modifiable. The simulator overwhelmingly received positive ratings in face and content validity, with mean scores of 4.8 and 4.7 of 5, respectively. Neurosurgeons deemed the simulator as highly accurate with respect to anatomical and tactile accuracy. Neurosurgical residents and neurosurgeons rated the simulator as superior in comparison with traditional teaching and training methods. The presented methodology demonstrates that the development and assessment of a high-fidelity hands-on simulator for the focused training of one of the most delicate neurosurgical procedures is achievable in a timely manner and without extensive investments.