Introduction: In the era of surgical resident work hour restrictions, the traditional apprenticeship model may provide fewer hours for neurosurgical residents to hone technical skills. Spinal dura mater closure or repair is one skill that is infrequently encountered and persistent cerebrospinal fluid leaks are a potential morbidity.

Methods: The Congress of Neurological Surgeons (CNS) has developed a simulation based model for durotomy closure with the ongoing efforts of their simulation educational committee. The core curriculum consists of a didactic component with concurrent technical simulation model of dural repair for the lumbar spine

Results: Didactic pre-test scores ranged from 4/11 (36%) to 10/11 (91%) median pre- and post-didactic scores 7 and 9, respectively. Post-test scores ranged from 8/11(73%) to 11/11 (100%). Overall, didactic improvements were demonstrated by all particitants (100%, P=0.02). The mean improvement was 1.17(18.5%). The technical component consisted of eleven durotomy closures by six participants, where four participants performed multiple durotomies. Mean time to closure of the durotomy ranged from 490 to 546 seconds in the first and second closures, respectively (P=0.66), whereby the median leak rate improved from 14 to 7 (P=0.34). There were also demonstrative technical improvements by all.

Conclusions: Simulated spinal dura mater repair appears to be a potentially valuable tool in the education of neurosurgery residents. The combination of a didactic and technical assessment appears to be synergistic in terms of educational development.

Patient Care: Better training on simulators with this didactic component should improve resident technical skills and translate into improved patient outcomes

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of didactic and technical components in neurosurgical education 2) Discuss, in the further advancement of education in neurosurgery 3) Understand the process to design and implement an educational algorithm

References: Faulkner ND, Finn MA, Anderson PA. Hydrostatic comparison of nonpenetrating titanium clips versus conventional suture for repair of spinal durotomies. Spine. Apr 20 2012;37(9):E535-539.