Journal of Surgical Simulation 2014; 1: 22 - 29

Published: 07 August 2014


Original article

Ventricular and skull base neuroendoscopy simulation in residency training: feasibility, cost, and resident feedback

Jaime Gasco, Achal Patel, Francisco Vaz GuimarĂ£es Filho, Samuel Zymberg, Juan Ortega-Barnett, Joel T. Patterson, Yong-Fan Kuo and Giselle Coelho
Corresponding author: Jaime Gasco, University of Texas Medical Branch, Division of Neurological Surgery, 301 University Boulevard, Galveston, TX 77555-0517, USA. Email:


Background: Shifting paradigms in neurosurgical education are promoting the development of different simulators in order to promote faster and safer surgical training. Neuroendoscopy simulators have been created with the intention of decreasing the learning curve of resident training in neuroendoscopy techniques. The objective was to study the potential usefulness of organized implementation of neuroendoscopy simulators in resident training, with particular attention to resident feedback and cost.

Methods: A total of 19 residents from two separate academic institutions performed 83 simulated endoscopic procedures. These were classified as ventricular (n = 49) and skull base (n = 34). In turn, each procedure was classified into one of three difficulty levels (easy, medium, and hard). Evaluations regarding self-perceived performance were completed after each exercise in accordance with a Physician Performance Diagnostic Inventory Scale based on the Likert format. Subject identification was blinded to junior or senior resident. Wilcoxon rank testing was used to compare the self-perceived performance improvement within and between both groups.

Results: Perceived improvement was statistically significant for all the ventricular and skull base/pituitary simulation procedures listed (P < 0.001) based on the Wilcoxon sign rank test. These results were not particularly influenced by simulation exercise group (ventricular vs skull base, P = 0.48), institution (United States vs Brazil, P = 0.44), resident training level (junior vs senior, P = 0.48), or the level of difficulty of the simulation procedure (easy, medium, hard, P = 0.98). The average cost of the ventricular and skull base/pituitary simulation modules was US$6367.50 and US$7065.50, respectively, per program.

Conclusion: The use of neuroendoscopic surgery simulators in neurosurgical training is regarded favorably by trainees and should be considered as an adjuvant in neurosurgical simulation training curricula.


Education; endoscopy; neurosurgery; simulation; training