Training in the practice of noninvasive brain stimulation: Recommendations from an IFCN committee.

As the field of noninvasive brain stimulation (NIBS) expands, there is a growing need for comprehensive guidelines on training practitioners in the safe and effective administration of NIBS techniques in their various research and clinical applications. This article provides recommendations on the structure and content of this training. Three different types of practitioners are considered (Technicians, Clinicians, and Scientists), to attempt to cover the range of education and responsibilities of practitioners in NIBS from the laboratory to the clinic. Basic or core competencies and more advanced knowledge and skills are discussed, and recommendations offered regarding didactic and practical curricular components. We encourage individual licensing and governing bodies to implement these guidelines.

Low-Cost Stereotactic Brain Biopsy Simulation Model.

OBJECTIVE: Simulation training improves technical skills in a safe environment. Stereotactic techniques are widely used in neurosurgery for different kinds of procedures. The objective of the study was to describe a combined cadaveric and synthetic low-cost stereotactic simulation model and its validation by neurosurgeons. METHODS: The brain was made using self-supporting gel with solid and cystic lesions. We used imaging scans to calculate x, y, and z target coordinates. A standard frame needle biopsy was performed. We calculated the number of mistakes and time needed to accomplish the task, and we evaluated the frame assembly and biopsy performance. Wilcoxon signed rank was used to analyzed the data; we considered a P value <0.05 as statistically significant. RESULTS: The median initial number of mistakes was 32 (interquartile range [IQR]: 27.5-37) and after repeated training and feedback the final median number was 3.5 (IQR: 2-6) (P < 0.001). The median time needed to finish the exercises before training was 1020.5 seconds (IQR: 908-1125.5) and after using the model the final median time was 479 seconds (IQR: 423-503) (P < 0.0001). CONCLUSIONS: We presented a stereotactic simulation model with immediate haptic feedback. The model can be easily handmade in any neurosurgical laboratory. This model allows neurosurgeons in training to acquire and improve stereotactic techniques, reducing the number of surgical mistakes and time needed to finish the task.

Acad. Prof. Yucel Kanpolat, Distinguished and Internationally Recognized Neurosurgeon and Friend of the Republic of Macedonia.

The sad news about the death of Acad. Yucel Kanpolat (September 17, 2016), a famous scholar, a pioneer in the field of neurosurgery, and a friend of the Republic of Macedonia, saddened the members of the Editorial Board of the journal PRILOZI of the Department of Medical Sciences of the Macedonian Academy of Sciences and Arts, of which he was a member, as well as the other members of the Academy. Yucel Kanpolat was an international figure, linking Turkey to almost every country in the world. Neurosurgery has lost a very special surgeon, scientist and humanitarian. During the visit to the Macedonian Academy of Sciences and Arts in 2011, we discussed the cooperation between the Turkish Academy of Sciences and the Macedonian Academy of Sciences and Arts, which he respected very much, as well as the role of the academies. He delivered a lecture on The Mission of Academia in the Age of Science, PRILOZI, MASA, XXXII, 2, p. 7-10 (2011), which we reprint in addition.

Development of a Standardized Cranial Phantom for Training and Optimization of Functional Stereotactic Operations.

BACKGROUND: In recent years, simulations based on phantom models have become increasingly popular in the medical field. In the field of functional and stereotactic neurosurgery, a cranial phantom would be useful to train operative techniques, such as stereo-electroencephalography (SEEG), to establish new methods as well as to develop and modify radiological techniques. In this study, we describe the construction of a cranial phantom and show examples for it in stereotactic and functional neurosurgery and its applicability with different radiological modalities. METHODS: We prepared a plaster skull filled with agar. A complete operation for deep brain stimulation (DBS) was simulated using directional leads. Moreover, a complete SEEG operation including planning, implantation of the electrodes, and intraoperative and postoperative imaging was simulated. RESULTS: An optimally customized cranial phantom is filled with 10% agar. At 7°C, it can be stored for approximately 4 months. A DBS and an SEEG procedure could be realistically simulated. Lead artifacts can be studied in CT, X-ray, rotational fluoroscopy, and MRI. CONCLUSIONS: This cranial phantom is a simple and effective model to simulate functional and stereotactic neurosurgical operations. This might be useful for teaching and training of neurosurgeons, establishing operations in a new center and for optimization of radiological examinations.

Robotics in neurosurgery: A literature review.

Robotic surgery has been the forte of minimally invasive stereo-tactic procedures for some decades now. Ongoing advancements and evolutionary developments require substantial evidence to build the consensus about its efficacy in the field of neurosurgery. Main obstacle in obtaining successful results in neurosurgery is fine neural structures and other anatomical limitations. Currently, human rationalisation and robotic precision works in symbiosis to provide improved results. We reviewed the current data about recent interventions. Robots are capable of providing virtual data, superior spatial resolution and geometric accuracy, superior dexterity, faster manoeuvring and non-fatigability with steady motion. Robotic surgery also allows simulation of virtual procedures which turn out to be of great succour for young apprentice surgeons to practise their surgical skills in a safe environment. It also allows senior professionals to rehearse difficult cases before involving into considerable risky procedures.

Egg Model Training Protocol for Stereotaxic Neurosurgery and Microelectrode Implantation.

BACKGROUND: Neuroscience research uses neurosurgery in animal models for several experimental techniques. To our knowledge, there is no published method for small animal neurosurgery training. Based on the similar thickness of chicken eggshells and mouse, rat, and some small primate skulls, here we propose an egg model training protocol for stereotaxic surgery. MATERIALS AND METHODS: To perform training it was used a boiled egg and the same materials needed to perform stereotaxic neurosurgery in small animals. DISCUSSION: This protocol allows trainees in neuroscience research to become familiar with the microsurgery setting and learn neurosurgery techniques, such as craniotomy drilling, dura mater removal, and electrode implantation. CONCLUSION: Egg model suitably mimics animal neurosurgery for the replacement and sparing of animals intended for training in neurosurgical skills.

Low-cost phantoms for training of stereotactic vacuum-assisted biopsy of the breast.

To test low-cost phantoms for training in stereotactic breast biopsy, we prepared eggplant with calcium powder; gelatin and turkey breast with coarse salt, peppercorns, and calcium powder, respectively; and short-bread pastry with salt. Three to 12 cores were harvested with an 11-gauge vacuum biopsy unit. Mammography images were taken before and after biopsy and from the biopsy cores. The pastry phantom provided the best simulation of microcalcifications for stereotactic biopsy with realistic cores, long durability, and short preparation time.

A training model head of plaster of Paris for stereotactic localization.

BACKGROUND: A head model for experiencing stereotactic localization will supply familiarity with stereotactic instruments and self confidence for attempters of stereotaxy before real experience. METHOD: Plaster of Paris was molded as a model head in a plastic ball. Then, it was partly chipped at its superior half, and metal pieces were inserted into those chipped surfaces. Later, the stereotactic frame was applied, and axial computed tomographic scanning was obtained. The metal pieces seen on scans were selected as targets, and their coordinates were calculated using the software of the stereotactic equipment. Lastly, the stereotactic needle was introduced with these coordinates for investigation of targeting. RESULTS: The model of plaster of Paris head was very suitable for rigid frame fixation. The metal pieces in the model head were clearly observed on computed tomographic scans. The stereotactic biopsy needle introduced with the perviously calculated coordinates was always successful in true targeting. CONCLUSION: This easily performed model head supplied us with familiarity with our stereotactic apparatus and convinced us for further attempts. This kind of model and more complicated ones may help for stereotaxy training in neurosurgery.

Low-cost phantom for stereotactic breast biopsy training.

OBJECTIVE: This article reports on the construction of a low-cost phantom to be used for training technologists, residents, and radiologists to perform stereotactic breast biopsy. The model is adaptable to a variety of biopsy devices and realistically simulates the aspects of stereotactic breast biopsy. CONCLUSION: We believe our model provides an excellent alternative to more expensive commercial products.