2009 Volume 37 Issue 6 Pages 429-433
We discuss the usefulness of a distal transsylvian (DTS) approach for microsurgical training of young neurosurgeons and assess the safety of this procedure by evaluating the complication ratio in our institute. In this procedure, residents learn the vulnerability of the pia mater, pial capillary vessels and small superficial sylvian veins and acquire the skill to avoid bleeding from these structures. In addition, if these vulnerable structures bleed, they learn how to keep the field dry by using suction or hemostatic materials without bipolar coagulation. These represent basic skills for dissecting the neck of an aneurysm safely and preserving critical perforators and nerves, which are the most vulnerable structures in aneurysmal surgery. From 1993 to 2008, this approach was used by 17 residents in 225 procedures. No morbidity or mortality caused by this procedure was observed.
For young neurosurgeons, the DTS approach is one of the best training methods to acquire delicate microsurgical skills that cannot be acquired in conventional off-the-job training.
