An Endoscopic Journey to the Center of the Skull Base for Novice Neurosurgeons: From Cadaver to Theater

Background: For novice neurosurgeons (nNS), it is important to determine the safety of extended-endoscopic endonasal approaches (eEEA) by analyzing/eliminating surgical drawbacks. Aim: To evaluate the impact of cadaveric training for nNS on reducing obstacles/complication rates in the operative theater.Subjects and Methods: This unique study has two parts: first; the lab/cadaveric part included a checklist scoring system to estimate the ability of nNS to dissect/identify basic and complex anatomical landmarks (BCAL) (n=50) via eEEA for the center of the skull base (CSB) using 2 formalin-fixed heads and a dry skull for tumor simulation. Second; theater/clinical part included 28 cases with sellar/suprasellar lesions.Results: In the lab, nNS could identify 60% (n=30) of all BCAL throughout their 50-hour hands-on intensive cadaveric training. They were able to identify 66.7% (n=10), 100% (n=13) and 31.8% (n=7) of pertinent nasal, sphenoidal and sellar/CSB landmarks, respectively. In theater, following cadaveric training, ergonomics were satisfactory without major complications. Nevertheless, the most frequent intraoperative obstacle for nNS was the loss of dynamic endoscopy/scissoring of instruments (17.8%) with occasional false trajectories or inadequate exposure of the landmarks (7%). We included pituitary adenomas (53.6%), tuberculum sellae meningiomas(7%), Rathke cleft cysts (RCCs) (18%), clival chordoma (3.6%), hypothalamic hamartoma (3.6%) and craniopharyngiomas(limited to the infra chiasmatic cistern without serious calcification) (14.2%). Gross total resection was achieved at (86%). A favourable outcome was achieved in 86%. Conclusion: Cadaveric training for nNS improves the quality of basic endoscopic CSB procedures, avoids hazardous maneuvers and reduces complication rate in theater.