Nicolai Maldaner1, Marketa Sosnova1, Johannes Sarnthein1, Oliver Bozinov1, Luca Regli1, Martin N Stienen2. 1. Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. 2. Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. mnstienen@gmail.com.
Abstract
BACKGROUND: There is a paucity of data concerning the safety and efficacy of surgical education for neurosurgical residents in the evacuation of chronic subdural hematomas (cSDH) by burr hole trepanation. METHODS: This is a retrospective analysis of prospectively collected data on consecutive patients receiving burr hole trepanation for uni- or bilateral cSDH. Patients operated by a supervised neurosurgery resident (teaching cases) were compared to patients operated by a board-certified faculty neurosurgeon (BCFN; non-teaching cases). The primary endpoint was surgical revision for any reason until the last follow-up. The secondary endpoint was occurrence of any complication until the last follow-up. Clinical status, type of complications, mortality, length of surgery (LOS), and hospitalization (LOH) were tertiary endpoints. RESULTS: A total of n = 253 cases were analyzed, of which n = 217 (85.8%) were teaching and n = 36 (14.2%) non-teaching cases. The study groups were balanced in terms of age, sex, surgical risk (ASA score), and preoperative status (Karnofsky Performance Scale (KPS), modified Rankin Scale (mRS), National Institute of Health Stroke Scale (NIHSS)). The cohort was followed for a mean of 242 days (standard deviation 302). In multivariate analysis, teaching cases were as likely as non-teaching cases to require revision surgery (OR 0.65, 95% CI 0.27-1.59; p = 0.348) as well as to experience any complication until the last follow-up (OR 0.79, 95% CI 0.37-1.67; p = 0.532). Mean LOS was about 10 min longer in teaching cases (53.0 ± 26.1 min vs. 43.5 ± 17.8 min; p = 0.036), but LOH was similar. There were no group differences in clinical status, mortality and type of complication at discharge, and the last follow-up. CONCLUSIONS: Burr hole trepanation for cSDH can be safely performed by supervised neurosurgical residents enrolled in a structured training program, without increasing the risk for revision surgery, perioperative complications, or worse outcome.
BACKGROUND: There is a paucity of data concerning the safety and efficacy of surgical education for neurosurgical residents in the evacuation of chronic subdural hematomas (cSDH) by burr hole trepanation. METHODS: This is a retrospective analysis of prospectively collected data on consecutive patients receiving burr hole trepanation for uni- or bilateral cSDH. Patients operated by a supervised neurosurgery resident (teaching cases) were compared to patients operated by a board-certified faculty neurosurgeon (BCFN; non-teaching cases). The primary endpoint was surgical revision for any reason until the last follow-up. The secondary endpoint was occurrence of any complication until the last follow-up. Clinical status, type of complications, mortality, length of surgery (LOS), and hospitalization (LOH) were tertiary endpoints. RESULTS: A total of n = 253 cases were analyzed, of which n = 217 (85.8%) were teaching and n = 36 (14.2%) non-teaching cases. The study groups were balanced in terms of age, sex, surgical risk (ASA score), and preoperative status (Karnofsky Performance Scale (KPS), modified Rankin Scale (mRS), National Institute of Health Stroke Scale (NIHSS)). The cohort was followed for a mean of 242 days (standard deviation 302). In multivariate analysis, teaching cases were as likely as non-teaching cases to require revision surgery (OR 0.65, 95% CI 0.27-1.59; p = 0.348) as well as to experience any complication until the last follow-up (OR 0.79, 95% CI 0.37-1.67; p = 0.532). Mean LOS was about 10 min longer in teaching cases (53.0 ± 26.1 min vs. 43.5 ± 17.8 min; p = 0.036), but LOH was similar. There were no group differences in clinical status, mortality and type of complication at discharge, and the last follow-up. CONCLUSIONS: Burr hole trepanation for cSDH can be safely performed by supervised neurosurgical residents enrolled in a structured training program, without increasing the risk for revision surgery, perioperative complications, or worse outcome.
Authors: Luis Padevit; Johannes Sarnthein; Martin Nikolaus Stienen; Niklaus Krayenbühl; Oliver Bozinov; Luca Regli; Marian Christoph Neidert Journal: J Neurooncol Date: 2019-06-11 Impact factor: 4.130
Authors: Flavio Vasella; Kevin Akeret; Nicolas R Smoll; Menno R Germans; Elisabeth Jehli; Oliver Bozinov; Luca Regli; Martin N Stienen Journal: Acta Neurochir (Wien) Date: 2018-08-28 Impact factor: 2.216
Authors: Flavio Vasella; Julia Velz; Marian C Neidert; Stephanie Henzi; Johannes Sarnthein; Niklaus Krayenbühl; Oliver Bozinov; Luca Regli; Martin N Stienen Journal: Sci Rep Date: 2019-01-30 Impact factor: 4.379
Authors: Martin N Stienen; Kevin Akeret; Flavio Vasella; Julia Velz; Elisabeth Jehli; Pierre Scheffler; Stefanos Voglis; Oliver Bichsel; Nicolas Roydon Smoll; Oliver Bozinov; Luca Regli; Menno R Germans Journal: BMJ Open Date: 2019-12-06 Impact factor: 2.692
Authors: Felix C Stengel; Maria L Gandia-Gonzalez; Cristina C Aldea; Jiri Bartek; Diogo Belo; Netanel Ben-Shalom; María F De la Cerda-Vargas; Evangelos Drosos; Christian F Freyschlag; Stanislav Kaprovoy; Milan Lepic; Laura Lippa; Katrin Rabiei; Giovanni Raffa; Bayron A Sandoval-Bonilla; Michael Schwake; Toma Spiriev; Cesare Zoia; Martin N Stienen Journal: Brain Spine Date: 2022-08-15