• Toshihiro Mashiko, Hirohumi Oguma, Takehiko Konno, Akira Gomi, Takashi Yamaguchi, Rie Nagayama, Makoto Sato, Ryo Iwase, and Kensuke Kawai.
• Department of Neurosurgery, Jichi Medical University School of Medicine, Tochigi, Japan. Electronic address: mashiko@jichi.ac.jp.
• World Neurosurg. 2018 Jan 1; 109: e298-e304.

IntroductionSelf-made devices composed of agar and gelatin gel were used for resident training in intra-axial brain tumor resection. The mixture gel of agar and gelatin is retractable and can be suctioned. Hardness of the gel depends on the concentration of the solution. Therefore, by changing the concentration, it is easy to make gels of various hardness.MethodsIn this study, a mass of gel that looked like a tumor was placed into another gel that looked like the brain. A part of the "brain" was regarded as the eloquent area. Three types of "tumor" were prepared: hard, moderately hard, and soft tumors. Residents tried to remove the tumor entirely with minimal brain invasion. The training was repeated with 3 types of gel. After resection, the weight of the residual tumor, resected normal brain, and resected eloquent area were measured, and the time taken for removal was recorded.ResultsThese data were compared between residents and neurosurgeons. We also analyzed how these data improved with repeated practice. In most cases, residual tumor, resected normal brain, resected eloquent area, and time taken for removal were less in neurosurgeons than in residents. Repeated training made residents more skillful. The responses of the trainees were almost all favorable.ConclusionsOur devices with "tumors" of various hardness appear to be suitable for resident training in each surgical skill. For the next step of this study, we will attempt to fabricate more practical 3-dimensional gel models for presurgical simulation.Copyright © 2017 Elsevier Inc. All rights reserved.

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