The Learning Curve in Skull Base Surgery Part 1­ From Historical-Philosophical Concepts to Microsurgical Lab Training

The learning curve reflects surgeons' experience in managing several patients with the same disease. In skull base surgery, the professional's place on the curve could be related to the number of times the same procedure was performed. Where does curve begin? What amount of training is necessary prior to its application in surgical settings? What were the results of the first few skull base tumor surgeries performed by a surgeon who goes on to produce excellent results, and how is reflected in the start of their learning curve? The only way for neurosurgeons to improve their results from the start is with prior training in the microsurgery laboratory. This learning technique is essential to maximize the chance of success of a neurosurgical procedures, minimizing the morbidity rate to which patients are subjected by less experienced neurosurgeons. This article is divided in two parts, and its purpose is to show how training in the microsurgical laboratory fits into the construction of knowledge about skull base surgery, based on authors' experience and reflections. This first part discusses the technical, psychological, and philosophical aspects of medical knowledge, primarily addressing those training in skull base surgery, the principles of some selected philosophical currents, and their influence on the development of current medical knowledge.

The Learning Curve in Skullbase Surgery Part 2­From the Microsurgical Lab Training to the Operative Room / A Curva de Aprendizado em Cirurgia de Base do Crânio - Do laboratório de microcirurgia à sala cirúrgica

In this second part, the authors review and suggest a methodology for studies in skull base surgery and training inmicrosurgical laboratory, based on their experiences and reflections. Not only are the foundations for the acquisition of microsurgical skills presented, but also what is needed to be an effective skullbase surgeon with good results. The present article reflects in particular the philosophy of professor Evandro de Oliveira and also serves to present to the neurosurgical community a new state-of-the-art laboratory for hands-on courses in Brazil, at the Faculdade Evangélica Mackenzie do Paraná.

Nesta segunda parte, os autores revisam e sugerem uma metodologia para o estudo em cirurgia de base de crânio e treinamento em laboratório de microcirurgia baseado em suas experiencias e reflexões. Não apenas os fundamentos para a aquisição de habilidades microcirúrgicas estão presentes, como também, o que é necessário para ser um eficiente cirurgião de base de crânio com bons resultados. Este artigo reflete, em particular, a filosofia do Professor Evandro de Oliveira, além de servir para apresentar a comunidade neurocirúrgica o novo "estado da arte" em laboratórios de cursos "hands-on" no Brasil, na Faculdade Evangélica Mackenzie do Paraná.