Enhancing Neurosurgical Training: A Comparative Study of Hybrid, Simulator-Based, and Body Donor-Based Dissection Courses.

Abstract

Neurosurgical training must balance anatomical realism with accessibility and safety. Body-donor dissection remains the gold standard but is limited by cost and availability. High-fidelity simulators offer structured, repeatable practice, although with reduced anatomical accuracy. Hybrid models combining simulation and body-donor dissection may offer improved educational value but remain understudied. The aim is to assess whether hybrid neurosurgical training improves anatomical knowledge and technical skills more effectively than simulator-only or body donor-only training. The primary outcome was the number of anatomical structures correctly identified during body-donor dissection. In this study, 66 participants (residents, junior neurosurgeons, and medical students) from 16 Italian institutions were assigned to one of three training groups: simulator-only (SIM; n=30), body donor-only (BD; n=20), or hybrid (HYB; n=16). All received a standardized lecture followed by practical sessions for pterional and retrosigmoid approaches. Post-course assessments included self-reported proficiency and objective anatomical structure identification. Statistical comparisons were adjusted for baseline surgical experience. The HYB group outperformed the BD group in anatomical identification during body-donor dissection (pterional: 12 vs 10 structures, p<0.01; retrosigmoid: 14 vs 11, p=0.03; total: 27 vs 21 identified structures, p=0.03). Effect sizes were large to very large (Cohen's d: 0.77-0.96). Prior simulation training improved recognition of key structures, including the petrosal vein, abducent nerve, and basilar artery. SIM and HYB groups performed similarly during the simulation session, confirming baseline comparability. Hybrid training integrating simulation and body donor dissection enhances anatomical learning and technical skill development. Simulation serves as a valuable preparatory step, improving performance during subsequent body-donor training, regardless of prior experience.