Subpial corticectomy simulation is a highly specialized procedure that involves recreating the surgical process of a subpial corticectomy in a controlled, virtual, or educational environment. The aim of this simulation can be to enhance surgical skills, train residents, or explore surgical strategies before performing on actual patients.

– Skill Acquisition: To train neurosurgeons or trainees in performing precise cortical resections.

– Preoperative Planning: To visualize and plan the approach to lesions in eloquent brain areas.

– Patient Safety: To practice techniques in a risk-free environment.

– Understanding Neuroanatomy: To study cortical and subcortical structures in detail.

– 3D Imaging Platforms: Use of advanced imaging technologies like MRI, fMRI, or DTI integrated into surgical simulation software.

– Virtual Reality (VR) Systems: Platforms like VR surgical simulators to recreate the tactile feedback and visual representation of the brain.

– NeuroNavigation Systems: Integrating systems like Medtronic StealthStation or Brainlab for accurate anatomical representation.

– Augmented Reality (AR): Overlaying virtual structures onto real-world models for enhanced surgical guidance.

– Haptic Feedback Devices: To mimic the feel of cutting or coagulating brain tissue.

1. Data Acquisition:

1. Collect patient-specific imaging data (MRI, CT) for realistic brain modeling.

2. Virtual Environment Setup:

1. Load imaging data into the simulation software.
2. Configure tools and settings specific to the procedure.

3. Preoperative Planning:

1. Identify the target area for corticectomy and any nearby eloquent regions.
2. Simulate mapping techniques (e.g., motor, sensory cortex).

4. Surgical Simulation:

1. Practice opening the dura, identifying gyri and sulci, and using subpial dissection techniques.
2. Simulate use of instruments like suction, bipolar coagulation, and microdissectors.

5. Complication Management:

1. Train for real-life scenarios like unexpected bleeding, eloquent cortex compromise, or equipment failure.

6. Postoperative Analysis:

1. Evaluate resection accuracy, complication rates, and adherence to surgical plans.

– Team-Based Training: Incorporate anesthetists, nursing staff, and assistants into simulations to mimic the operating room dynamic.

– Feedback Mechanisms: To evaluate performance, use metrics like accuracy, time taken, and safety.

– Case Reviews: Discuss simulated cases in grand rounds or workshops.

– AI Integration: Use AI to guide surgical decision-making based on simulation performance.

– Remote Simulation Platforms: Allow surgeons worldwide to train collaboratively in a shared virtual space.

– Personalized Simulations: Tailor models to patient-specific anatomy and pathology for preoperative rehearsals.

Subpial corticectomy involving complete lesion resection while preserving pial membranes and avoiding injury to adjacent normal tissues is an essential bimanual task necessary for neurosurgical trainees to master. Almansouri et al. sought to develop an ex vivo calf brain corticectomy simulation model with continuous assessment of neurosurgical instruments movement during the simulation. A case series study of skilled participants was performed to assess face and content validity to gain insights into the utility of this training platform, along with determining if skilled and less skilled participants had statistical differences in validity assessment.

An ex vivo calf brain simulation model was developed in which trainees performed a subpial corticectomy of three defined areas. A case series study assessed the face and content validity of the model using 7-point Likert scale questionnaires.

Twelve skilled and 11 less skilled participants were included in this investigation. Overall median scores of 6.0 (range 4.0-6.0) for face validity and 6.0 (range 3.5-7.0) for content validity were determined on the 7-point Likert scale, with no statistical differences between skilled and less skilled groups identified.

A novel ex vivo calf brain simulator was developed to replicate the subpial resection procedure and demonstrated face and content validity ¹⁾

Almansouri et al.’s study represent a valuable contribution to neurosurgical training, offering a novel approach to simulating subpial corticectomy. While the model demonstrates face and content validity, further research is needed to establish its broader applicability and impact on neurosurgical education. Incorporating additional validation metrics and expanding the study’s scope could significantly enhance the simulator’s utility as a training tool.

Santos et al. describe a cadaveric model simulating the resection of a temporo-insular low-grade glioma. Klingler method technique was used to fix the cadaver head before injecting red and blue colorants for a realistic vascular appearance. The hemisphere was frozen for white matter tract dissection. Tractography and intraoperative eloquent areas were extrapolated from a glioma patient by using a neuronavigation system. Then, a frontotemporal craniotomy was performed through a question mark incision, exposing the inferior temporal gyrus up to the middle frontal gyrus. After cortical anatomic landmark identification, eloquent areas were extrapolated creating a simulated functional cortical map. Then, trans opercular non eloquent frontal and temporal corticectomies were performed, followed by subpial resection. Detailed identification of Sylvian vessels and insular cortex was demonstrated. Anatomic resection limits were exposed, and implicated white matter bundles, uncinate, and fronto-occipital fascicles, were identified running through the temporal isthmus. Finally, a temporo-mesial resection was performed. In summary, this model provides a simple, cost-effective, and very realistic simulation of a trans-opercular approach to the insula, allowing the development of surgical skills needed to treat insular tumors in a safe environment. Besides, the integration of simulated navigation has proven useful in better understanding the complex white matter anatomy involved. Cadaver donation, subject or relatives, includes full consent to publish the images. For this video, no ethics committee approval was needed. Images correspond to a cadaver head donation. Cadaver donation, subject or relatives, includes full consent for any scientific purposes involving the corpse. The consent includes an image or video recording. Regarding the intraoperative surgical video and tractography, the patient gave written consent for scientific divulgation before surgery ²⁾.

This cadaveric-based model, as described by Santos et al., is an exemplary tool for advancing neurosurgical education. Despite some inherent limitations, it provides a robust framework for learning the surgical nuances of temporo-insular tumor resections, fostering both anatomical understanding and technical proficiency in a controlled, ethical, and cost-effective manner.