An Endoscopic Journey to the Center of the Skull Base for Novice Neurosurgeons: From Cadaver to Theater

Authors

Alhusain Nagm, Department of Neurosurgery, Al-Azhar University School of Medicine, Cairo, Egypt.Follow
Mohammed Hamadah, Department of Neurosurgery, Al-Azhar University School of Medicine, Cairo, Egypt.
Kamal Elbaz, Department of Anatomy, Al-Azhar University School of Medicine, Cairo, Egypt.
Ibrahim Ewiss, Department of Neurosurgery, Al-Azhar University School of Medicine, Cairo, Egypt

Corresponding Author

Alhusain Nagm

Authors ORCID

0000-0003-0469-4970

Document Type

Original Article

Abstract

Background: For novice neurosurgeons (nNS), it is important to determine the safety of extended-endoscopic endonasal approaches (eEEA) by analyzing/eliminating surgical drawbacks. Aim: To evaluate the impact of cadaveric training for nNS on reducing obstacles/complication rates in the operative theater.

Subjects and Methods: This unique study has two parts: first; the lab/cadaveric part included a checklist scoring system to estimate the ability of nNS to dissect/identify basic and complex anatomical landmarks (BCAL) (n=50) via eEEA for the center of the skull base (CSB) using 2 formalin-fixed heads and a dry skull for tumor simulation. Second; theater/clinical part included 28 cases with sellar/suprasellar lesions.

Results: In the lab, nNS could identify 60% (n=30) of all BCAL throughout their 50-hour hands-on intensive cadaveric training. They were able to identify 66.7% (n=10), 100% (n=13) and 31.8% (n=7) of pertinent nasal, sphenoidal and sellar/CSB landmarks, respectively. In theater, following cadaveric training, ergonomics were satisfactory without major complications. Nevertheless, the most frequent intraoperative obstacle for nNS was the loss of dynamic endoscopy/scissoring of instruments (17.8%) with occasional false trajectories or inadequate exposure of the landmarks (7%). We included pituitary adenomas (53.6%), tuberculum sellae meningiomas(7%), Rathke cleft cysts (RCCs) (18%), clival chordoma (3.6%), hypothalamic hamartoma (3.6%) and craniopharyngiomas(limited to the infra chiasmatic cistern without serious calcification) (14.2%). Gross total resection was achieved at (86%). A favourable outcome was achieved in 86%. Conclusion: Cadaveric training for nNS improves the quality of basic endoscopic CSB procedures, avoids hazardous maneuvers and reduces complication rate in theater.

Keywords

endoscopic endonasal approach, skull base, cadaver, sella, anatomy.

Subject Area

Neurosurgery

How to Cite This Article

Nagm, Alhusain; Hamadah, Mohammed; Elbaz, Kamal; and Ewiss, Ibrahim (2023) "An Endoscopic Journey to the Center of the Skull Base for Novice Neurosurgeons: From Cadaver to Theater," Al-Azhar International Medical Journal: Vol. 4: Iss. 8, Article 1.
DOI: https://doi.org/10.58675/2682-339X.1927