ABSTRACT
OBJETIVO: Cuantificar la experiencia quirúrgica obtenida por los residentes del programa de especialización en neurocirugía durante un periodo de 6 meses. MATERIAL Y MÉTODO: Un total de 13 residentes se registraron en el programa de especialización en neurocirugía en el periodo de febrero a julio de 2018. Durante este periodo se documentaron en el Registro Neuroquirúrgico Electrónico los procedimientos en los que cada residente participó y el rol que desempeñó. Los residentes que se retiraron del programa fueron excluidos. RESULTADOS: Se realizaron 530 procedimientos en el periodo de estudio. El aprendizaje por observación y la práctica tutelada se realizan principalmente en el primer y quinto año de residencia, periodos durante los cuales el residente comienza su aprendizaje en el área cirugías de urgencias y electivas, respectivamente. Posteriormente es capaz de realizar cirugías de manera autónoma, en el bloque de urgencias, durante el segundo y tercer año; y en el bloque de cirugías electivas, en el sexto año. El residente es capaz de instruir a cirujanos menos experimentados en el cuarto año. CONCLUSIONES: El Registro Neuroquirúrgico Electrónico es una herramienta tecnológica innovadora que apoya en los campos de asistencia, docencia e investigación. Permite conocer con exactitud la cantidad de pacientes que han sido intervenidos quirúrgicamente en un determinado momento, lo cual brinda información valiosa para el manejo adecuado de recursos. Los datos obtenidos permiten identificar áreas de oportunidad en el entrenamiento de los residentes, lo que permite el desarrollo de estrategias para la mejora continua en la formación de neurocirujanos competentes
OBJECTIVE: To quantify the surgical experience acquired by residents in the neurosurgery specialisation programme over a 6-month period. MATERIALS AND METHODS: A total of 13 residents enrolled in the neurosurgery specialisation programme from February 2018 to July 2018. Over this period, the procedures residents were involved in and the role they played were documented in the Electronic Neurosurgical Register. Residents who withdrew from the specialisation program were excluded. RESULTS: A total of 530 procedures were performed during the study period. Observational learning and supervised practice are conducted primarily in the first and fifth years of residence, during which residents begin their training in emergency and elective surgeries, respectively. Residents are then able to independently perform emergency surgeries during the second and third years, and elective surgeries in the sixth year. Residents are able to instruct less experienced surgeons in the fourth year. CONCLUSIONS: The Electronic Neurosurgical Register is an innovative technological tool that supports the fields of care, teaching and research. It records the exact number of patients who have undergone surgery at a particular time, providing valuable information for the proper management of resources. The data obtained can be used to identify areas of opportunity in the training of residents, facilitating the development of continuous improvement strategies in the training of competent neurosurgeons
Subject(s)
Humans , Mobile Applications , Neurosurgical Procedures/education , Neurosurgery/education , Internship and Residency , Education, Distance , Electronic Health RecordsABSTRACT
OBJECTIVE: To quantify the surgical experience acquired by residents in the neurosurgery specialisation programme over a 6-month period. MATERIALS AND METHODS: A total of 13 residents enrolled in the neurosurgery specialisation programme from February 2018 to July 2018. Over this period, the procedures residents were involved in and the role they played were documented in the Electronic Neurosurgical Register. Residents who withdrew from the specialisation program were excluded. RESULTS: A total of 530 procedures were performed during the study period. Observational learning and supervised practice are conducted primarily in the first and fifth years of residence, during which residents begin their training in emergency and elective surgeries, respectively. Residents are then able to independently perform emergency surgeries during the second and third years, and elective surgeries in the sixth year. Residents are able to instruct less experienced surgeons in the fourth year. CONCLUSIONS: The Electronic Neurosurgical Register is an innovative technological tool that supports the fields of care, teaching and research. It records the exact number of patients who have undergone surgery at a particular time, providing valuable information for the proper management of resources. The data obtained can be used to identify areas of opportunity in the training of residents, facilitating the development of continuous improvement strategies in the training of competent neurosurgeons.
Subject(s)
Internship and Residency , Mobile Applications , Neurosurgery , Humans , Neurosurgeons , Neurosurgery/education , Neurosurgical ProceduresABSTRACT
OBJECTIVECranioplasty implants should be widely available, low in cost, and customized or easy to mold during surgery. Although autologous bone remains the first choice for repair, it cannot always be used due to infection, fragmentation, bone resorption, or other causes, which led to use of synthetic alternatives. The most frequently used allogenic material for cranial reconstructions with long-term results is polymethylmethacrylate (PMMA). Three-dimensional printing technology has allowed the production of increasingly popular customized, prefabricated implants. The authors describe their method and experience with a customized PMMA prosthesis using a precise and reliable low-cost implant that can be customized at any institution with open-source or low-cost software and desktop 3D printers.METHODSA review of 22 consecutive patients undergoing CT-based, low-cost, customized PMMA cranioplasty over a 1-year period at a university teaching hospital was performed. Preoperative data included patient sex and age; CT modeling parameters, including the surface area of the implant (defect); reason for craniectomy; date(s) of injury and/or resections; the complexity of the defect; and associated comorbidities. Postoperative data included morbiditiy and complications, such as implant exposure, infection, hematoma, seroma, implant failure, and seizures; the cost of the implant; and cosmetic outcome.RESULTSIndications for the primary craniectomy were traumatic brain injury (16, 73%), tumor resection (3, 14%), infection (1, 4%), and vascular (2, 9%). The median interval between previous surgery and PMMA cranioplasty was 12 months. The operation time ranged from 90 to 150 minutes (mean 126 minutes). The average cranial defect measured 65.16 cm2 (range 29.31-131.06 cm2). During the recovery period, there was no sign of infection, implant rejection, or wound dehiscence, and none of the implants had to be removed over a follow-up ranging from 1 to 6 months. The aesthetic appearance of all patients was significantly improved, and the implant fit was excellent.CONCLUSIONSThe use of a customized PMMA was associated with excellent patient, family, and surgeon satisfaction at follow-up at a fraction of the cost associated with commercially available implants. This technique could be an attractive option to all patients undergoing cranioplasty.
ABSTRACT
Intracranial pial arteriovenous fistulas, also known as nongalenic fistulas, are rare vascular malformations affecting predominantly the pediatric population. Hydrocephalus is an unusual presentation in which the exact pathophysiology is not fully understood. The aim of treatment in these cases is occlusion of the fistula prior to considering ventricular shunting. Here, the authors describe the hydrodynamic considerations of the paravascular pathway and the resolution of hydrocephalus with endovascular treatment of the fistula.
