• World Neurosurg · Feb 2021

    Changing Hands: A Rising Role of the Tumor Surgeon in Teaching Sylvian Fissure Dissection.

    • Stephen G Bowden, Dominic A Siler, Stephanie Radu, S Cody Schoettler Woll, Ali I Rae, Barry Cheaney, Joseph G Nugent, Brittany Stedelin, Justin S Cetas, Aclan Dogan, and Seunggu J Han.
    • Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA.
    • World Neurosurg. 2021 Feb 1; 146: e86-e90.

    ObjectiveThe landscape of microneurosurgery has changed considerably over the past 2 decades, with a decline in indications for open surgery on cerebrovascular pathology and ever-increasing indications for open resection of brain tumors. This study investigated how these trends in case volume affected residents' training experiences in microsurgery and, specifically, Sylvian fissure dissection.MethodsResident case logs were reviewed, identifying open cerebrovascular operations and craniotomies for tumor. Operations involving Sylvian fissure dissection were identified through operative reports. Changes in case number by resident were plotted over time, and linear regression was applied.ResultsAmong 23 chief residents, 3045 operations were identified, 1071 of which were for cerebrovascular pathology and 1974 for tumor. Open cerebrovascular experience decreased (P < 0.0001) while tumor volume remained unchanged (P = 0.221). The number of Sylvian fissure dissections per resident did not change over time overall (P = 0.583) or within cerebrovascular operations (P = 0.071). The number of Sylvian fissure dissections in tumor operations increased (P = 0.004). This effect was predominated by an increase in intraaxial tumors approached via Sylvian fissure dissection (P = 0.003). The proportion of Sylvian fissure dissections in tumor surgery increased from 15% in 2009 to 34% by 2019 (P = 0.003).ConclusionsResidents are seeing an increasing proportion of their Sylvian fissure dissection experience during tumor operations. The distribution of this experience will continue to evolve as surgical indications change but suggests a growing role for tumor surgeons in resident training in microsurgery.Copyright © 2020 Elsevier Inc. All rights reserved.

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