• Grazia Menna, Angelos Kolias, Ignatius N Esene, Ernest J Barthélemy, Samer Hoz, Tsegazeab Laeke, Veiga SilvaAna CristinaACFederal University of Pernambuco, Recife, Pernambuco, Brazil; Department of Neurosurgery, Hospital of Restauraçao, Recife, Pernambuco, Brazil., Gabriel Mauricio Longo-Calderón, Ronnie E Baticulon, Joaquín Pérez Zabala, Fahd Derkaoui Hassani, Naija El Abbadi, Muhammad Mukhtar Khan, Faith C Robertson, Nqobile Thango, Beverly Cheresem, Elizabeth Ogando-Rivas, Louis-Georges Roumy, Claire Karekezi, Alexander Alamri, Giannantonio Spena, Marco Cenzato, Franco Servadei, Carlo Giorgio Giussani, and Federico Nicolosi.
• Neurosurgery Unit, Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; NIHR Global Health Research Group on Acquired Brain and Spine Injury (ABSI), University of Cambridge, Cambridge, UK. Electronic address: mennagrazia@gmail.com.
• World Neurosurg. 2024 Feb 1; 182: e792e797e792-e797.

IntroductionCentral to neurosurgical care, neurosurgical education is particularly needed in low- and middle-income countries (LMICs), where opportunities for neurosurgical training are limited due to social and economic constraints and an inadequate workforce. The present paper aims (1) to evaluate the validity and usability of a cadaver-free hybrid system in the context of LMICs and (2) to report their learning needs and whether the courses meet those needs via a comprehensive survey.MethodsFrom April to November 2021, a non-profit initiative consisting of a series of innovative cadaver-free courses based on virtual and practical training was organized. This project emerged from a collaboration between the Young Neurosurgeons Forum of the World Federation of Neurological Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and UpSurgeOn, an Italian hi-tech company specialized in simulation technologies, creator of the UpSurgeOn Box, a hyper-realistic simulator of cranial approaches fused with augmented reality. Over that period, 11 cadaver-free courses were held in LMICs using remote hands-on Box simulators.ResultsOne hundred sixty-eight participants completed an online survey after course completion of the course. The anatomical accuracy of simulators was overall rated high by the participant. The simulator provided a challenging but manageable learning curve, and 86% of participants found the Box to be very intuitive to use. When asked if the sequence of mental training (app), hybrid training (Augmented Reality), and manual training (the Box) was an effective method of training to fill the gap between theoretical knowledge and practice on a real patient/cadaver, 83% of participants agreed. Overall, the hands-on activities on the simulators have been satisfactory, as well as the integration between physical and digital simulation.ConclusionsThis project demonstrated that a cadaver-free hybrid (virtual/hands-on) training system could potentially participate in accelerating the learning curve of neurosurgical residents, especially in the setting of limited training possibilities such as LMICs, which were only worsened during the COVID-19 pandemic.Copyright © 2023 Elsevier Inc. All rights reserved.

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