脳動脈瘤クリッピングの術者教育

Abstract

We introduce our program for training microsurgical operators in aneurysm clipping. We also discuss risk management of senior operators in surgical training courses for aneurysm clipping. In this program, the neurosurgical resident is assigned to perform clipping for 20 cases of cerebral aneurysm with relatively low surgical risk. The resident must make a detailed preoperative report on head position, skin incision, craniotomy, dissection of fissure and aneurysm, clip type and assumed risks associated with each procedure. A senior operator then examines and approves the report. Intraoperatively, the resident is required by the senior operator to maintain a bloodless operative field and operate under high magnification to confirm safety. The senior operator confirms in a timely manner that the resident is operating according to the operation plan and also is prepared to deal with unexpected situations such as premature rupture of the aneurysm. The senior operator evaluates each technique of the resident, and takes over temporarily when the resident performs a procedure associated with an increased risk of complications. Between 2007 and 2012, this program had 10 resident participants, five of whom completed it. In this program, temporary deficits were observed in four cases (4.2%); however, no permanent deficits were noted. This program for aneurysm clipping allows safe, effective training of microsurgical operators.