私の手術教育 : 初心者指導の経験から(<特集>手術教育)  [in Japanese] The Education for Young Neurosurgeons(<Topic>Training System for Young Neurosurgeons)  [in Japanese]

Recently, better direct surgery for cerebrovascular disease has come to be required, while less invasive treatment (gamma knife and intravascular surgery) has played an alternative role. To improve the quality of surgery, one of the most important issues is the surgical education of young neurosurgeons. They must learn traditional surgical skills and achieve more sophisticated techniques than those of their seniors. In this paper, I present my experience and discuss the education of neurosurgeons. My teaching method was based on suturing training with 10-0 nylon using a microscope and hands-on practice under my supervision. This training was useful to improve dexterity and maneuverability with a limited number of clinical cases. The hands-on practice of microsurgery was inevitable to learn surgical skills and judgment. Moreover, the experience of real surgery was an incentive to train harder. My residents trained in suturing for 1 to 3 years with a total of 10, 000 to 20, 000 stitches each. During the same period, they operated on 150-250 cases, including aneurysmal clipping (20-50 cases), STA-MCA anastomosis (5-20) and carotid endarterectomy (5-30). Surgical complication was 1-2% of all, although the time of surgery was prolonged in the early stage. Differences of resident's grades at the start of training were not related to the results. Satisfactory results were not achieved in less than 2 years. In my subjective judgment, the result of education depended on the individual passion for surgery, the continuous training and a positive attitude about learning from others. Even young neurosurgeons should be given a chance to perform microsurgery if they continue the training. Under a senior's supervision, the results of surgery can be acceptable. Early experience and education may be promising for improving microsurgery for cerebrovascular disease.