Neurosurgery
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Historical Article
Neurosurgery simulation in residency training: feasibility, cost, and educational benefit.
The effort required to introduce simulation in neurosurgery academic programs and the benefits perceived by residents have not been systematically assessed. ⋯ The systematic implementation of a simulation curriculum in a neurosurgery training program is feasible, is favorably regarded, and has a positive impact on trainees of all levels, particularly in junior years. All simulation forms, cadaver, physical, and haptic/computerized, have a role in different stages of learning and should be considered in the development of an educational simulation program.
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En bloc wide-margin excision significantly decreases the risk of chordoma recurrence. However, a wide surgical margin cannot be obtained in many chordomas because they arise primarily in the sacrum, clivus, and mobile spine. Furthermore, these tumors have shown resistance to fractionated photon radiation at conventional doses and numerous chemotherapies. ⋯ High-dose single-fraction SRS provides good tumor control with low treatment-related morbidity. Additional follow-up is required to determine the long-term recurrence risk.
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Historical Article
History of the Department of Neurosurgery at Thomas Jefferson University Hospital.
The neurosurgical tradition at Jefferson Medical College began in the 19th century with Samuel Gross. In his textbook entitled A System of Surgery, Gross revealed his knowledge of the disorders of the nervous system at a time when innovations were practically inexistent. Gross' work paved the way for William Williams Keen, "America's first brain surgeon." In 1887, Keen became the first surgeon in the nation to successfully remove a primary brain tumor. ⋯ Osterholm became chairman of the Department of Neurosurgery in 1974. Since 2004, Robert Rosenwasser has served as chairman, and the Department of Neurosurgery at Jefferson has grown to include 26 faculty members. The residency has expanded to include 3 residents per academic year since 2007.
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Surgical education is moving rapidly to the use of simulation for technical training of residents and maintenance or upgrading of surgical skills in clinical practice. To optimize the learning exercise, it is essential that both visual and haptic cues are presented to best present a real-world experience. Many systems attempt to achieve this goal through a total virtual interface. ⋯ The system has provided the residents an opportunity to understand and appreciate the complex 3-dimensional anatomy of the 3 neurosurgical procedures simulated. The systems have also provided an opportunity to break procedures down into critical segments, allowing the user to concentrate on specific areas of deficiency.
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A virtual reality (VR) neurosurgical simulator with haptic feedback may provide the best model for training and perfecting surgical techniques for transsphenoidal approaches to the sella turcica and cranial base. Currently there are 2 commercially available simulators: NeuroTouch (Cranio and Endo) developed by the National Research Council of Canada in collaboration with surgeons at teaching hospitals in Canada, and the Immersive Touch. Work in progress on other simulators at additional institutions is currently unpublished. ⋯ CTA, cognitive task analysisVR, virtual reality.