Reshaping neurosurgical training: a novel simulation-based concept for structured skill acquisition and curriculum integration

As neurosurgical caseloads decline, alternative training methods are essential for practical, hands-on training and technical skill acquisition. Physical simulators have the potential to enhance surgical training, but current models lack realism and fail to replicate the full surgical workflow. This study aims to develop and evaluate a novel, affordable microneurosurgical simulator designed for structured, effective and transferable skill acquisition. Based on previously established methodologies, we developed a novel high-fidelity yet cost-effective simulator that replicates the key steps of the neurosurgical workflow, including patient positioning, craniotomy, microsurgical dissection, clipping of aneurysms, tumor resection, and closure techniques. The simulator's fidelity was validated through intense rheological testing and tactile evaluations by experienced neurosurgeons. It was subsequently implemented in a two-day microneurosurgical simulation course involving 12 neurosurgical residents from leading German institutions. Participants completed pre- and post-course evaluations. Objective evaluations of technical proficiency and surgical learning curves were conducted using a newly developed tool-the Objective Structured Assessment of Neurosurgical Skills (OSANS). Participants rated the simulator highly for anatomical accuracy and tactile realism, with 95% considering it "highly realistic." Objective assessments revealed significant improvements in technical skills, including craniotomy precision and dural closure. Confidence in performing complex neuro-oncological and vascular procedures increased by 40%. Incorporating simulation-based training into neurosurgical curricula can enhance resident education, improve skill acquisition, and promote patient safety. This presented cost-effective, reusable simulator bridges gaps in neurosurgical training by enabling realistic and repetitive practice.