Introduction: Given recent technological advances, endoscopic third ventriculostomy (ETV) has become the standard-of-care for managing obstructive hydrocephalus.[1] However, ETV introduces novel challenges for surgical trainees, including loss of tactile feedback, adapting to a 2D visual environment, and manipulating instruments with very limited degrees of freedom in narrow, high-risk spaces.[2] The need to develop these skills provides a unique opportunity to introduce VR simulation training into the neurosurgical training paradigm. The purpose of this study was to conduct a national needs assessment, addressing specific goals of instruction, to guide the development of a VR simulator and curriculum for ETV.
Methods: Canadian neurosurgeons who perform ETV in their clinical practice were invited to participate. Using mixed-methods survey methodology, we developed a 10-item, structured, online questionnaire. Items pertained to the procedural steps for ETV, the frequency and significance of intraoperative errors committed while learning the technique, and simulation training modules of greatest potential educational benefit. Descriptive data analysis was completed for both quantitative and qualitative responses.
Results: 32 of 58 (55.2%) surgeons completed the survey. All believed a VR simulator for ETV would be a valuable addition to clinical training (Figure 1). Identification of ventriculostomy site, navigation within the ventricular system and performance of the ventriculostomy ranked among the most important steps to simulate. Technically inadequate ventriculostomy, inappropriate fenestration site selection and failure to abort the procedure appropriately were cited as the most frequent/significant errors. A standard module and technically unsafe ETV scenario were felt to be most beneficial for resident training.
Conclusions: As a first step in developing a simulation-training program for neuroendoscopy, we have conducted a national survey of attending surgeons regarding the training needs for endoscopic third ventriculostomy. The results provide valuable insight to inform key design elements necessary to construct an educationally relevant device and educational program.
Patient Care: Simulation training is free from concerns over patient safety and limited clinical resources. As such, they provide an ideal ‘no-risk’ environment where surgical skills can be developed through harmless repetition. This research provides valuable insight into the development of educationally relevant simulators and training curricula, in hopes of mitigating surgical errors committed during training, thereby improving patient safety.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Identify the potential to address the neuroendoscopic learning needs of neurosurgical trainees through simulation-based education
2) Describe the key procedural steps, intraoperative errors, and simulation modules best suited to meet the learning needs of trainees for endoscopic third ventriculostomy
3) Articulate how this information can be used to devlop an educationally relevant simulator and training program for endoscopic third ventriculostomy
References: 1. deRibaupierre S, Rilliet B, Vernet O, Regli L, Villemure JG. Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: results from a Swiss series and literature review. Child's Nervous System. 2007;23(5):527–533.
2. Haase J, Boisen E. Neurosurgical training: more hours needed or a new learning culture? Surgical Neurology. 2009;72(1):89–95; discussion 95–7.