• Alessandro Perin, Enrico Gambatesa, Tommaso Francesco Galbiati, Claudia Fanizzi, Giovanni Carone, Chiara Benedetta Rui, Roberta Ayadi, Andrea Saladino, Luca Mattei, Francois Yves Legninda Sop, Chiara Caggiano, Francesco Ugo Prada, Francesco Acerbi, Paolo Ferroli, Torstein Ragnar Meling, and Francesco DiMeco.
• Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy; Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy; Department of Life Sciences, University of Trieste, Trieste, Italy. Electronic address: aperin@gmail.com.
• World Neurosurg. 2021 Oct 1; 154: e130-e146.

ObjectiveSurgical clipping has become a relatively rare procedure in comparison to endovascular exclusion of cerebral aneurysms. Consequently, there is a declining number of cases where young neurosurgeons can practice clipping. For this reason, we investigated the application of a new 3-dimensional (3D) simulation and rehearsal device, Surgical Theater, in vascular neurosurgery.MethodsWe analyzed data of 20 patients who underwent surgical aneurysm clipping. In 10 cases, Surgical Theater was used to perform the preoperative 3D planning (CASCADE group), while traditional imaging was used in the other cases (control group). Preoperative 3D simulation was performed by 4 expert and 3 junior neurosurgeons (1 fellow, 2 residents). During postoperative debriefings, expert surgeons explained the different aspects of the operation to their younger colleagues in an interactive way using the simulator. Questionnaires were given to the surgeons to get qualitative feedback about the simulator, and the junior surgeons' performance at simulator was also analyzed.ResultsThere were no differences in surgery outcomes, complications, and surgical duration (P > 0.05) between the 2 groups. Senior neurosurgeons performed similarly when operating at the simulator as compared with in the operating room, while junior neurosurgeons improved their performance at the simulator after the debriefing session (P < 0.005).ConclusionsSurgical Theater proved to be realistic in replicating vascular neurosurgery scenarios for rehearsal and simulation purposes. Moreover, it was shown to be useful for didactic purposes, allowing young neurosurgeons to take full advantage and learn from senior colleagues to become familiar with this demanding neurosurgical subspecialty.Copyright © 2021 Elsevier Inc. All rights reserved.

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