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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(04): e340-e347
DOI: 10.1055/s-0042-1758220
Original Article

The Learning Curve in Skull Base Surgery Part 1–From Historical-Philosophical Concepts to Microsurgical Lab Training

Gustavo Rassier Isolan
1   The Center for Advanced Neurology and Neurosurgery (CEANNE), Brazil
2   Evangelical Mackenzie University of Paraná, Bigorrilho, Curitiba, PR, Brazil
3   The Center for Neurotology and Acoustic Neuroma (CNNA), Porto Alegre, Brazil
,
Jander Monteiro
1   The Center for Advanced Neurology and Neurosurgery (CEANNE), Brazil
,
Marco Antônio Schlindwein Vaz 
1   The Center for Advanced Neurology and Neurosurgery (CEANNE), Brazil
,
Joel Lavinsky
1   The Center for Advanced Neurology and Neurosurgery (CEANNE), Brazil
3   The Center for Neurotology and Acoustic Neuroma (CNNA), Porto Alegre, Brazil
4   Lavinsky Clinic, Porto Alegre, Brazil
,
Ricardo Lopes de Araújo
5   Department of Neurological Surgery, Laboratory of Surgical Innovations for Skull Base Microneurosurgery, Weill Cornell Medical College, New York, NY, USA
,
Giuseppe Santis
1   The Center for Advanced Neurology and Neurosurgery (CEANNE), Brazil
,
Eberval Gadelha Figueiredo
6   Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil
,
Viviane Buffon
1   The Center for Advanced Neurology and Neurosurgery (CEANNE), Brazil
2   Evangelical Mackenzie University of Paraná, Bigorrilho, Curitiba, PR, Brazil
,
Carmem Austrália Paredes Ribas Filho
2   Evangelical Mackenzie University of Paraná, Bigorrilho, Curitiba, PR, Brazil
,
Jurandir Marcondes Ribas Filho
2   Evangelical Mackenzie University of Paraná, Bigorrilho, Curitiba, PR, Brazil
,
Osvaldo Malafaia
2   Evangelical Mackenzie University of Paraná, Bigorrilho, Curitiba, PR, Brazil
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Abstract

The learning curve reflects surgeons' experience in managing several patients with the same disease. In skull base surgery, the professional's place on the curve could be related to the number of times the same procedure was performed. Where does curve begin? What amount of training is necessary prior to its application in surgical settings? What were the results of the first few skull base tumor surgeries performed by a surgeon who goes on to produce excellent results, and how is reflected in the start of their learning curve? The only way for neurosurgeons to improve their results from the start is with prior training in the microsurgery laboratory. This learning technique is essential to maximize the chance of success of a neurosurgical procedures, minimizing the morbidity rate to which patients are subjected by less experienced neurosurgeons. This article is divided in two parts, and its purpose is to show how training in the microsurgical laboratory fits into the construction of knowledge about skull base surgery, based on authors' experience and reflections. This first part discusses the technical, psychological, and philosophical aspects of medical knowledge, primarily addressing those training in skull base surgery, the principles of some selected philosophical currents, and their influence on the development of current medical knowledge.

Keywords

skull-base - learning curve - microsurgical laboratory

Note

Some small parts of this article were published previously in Portuguese by the senior author, * but with a different focus on the learning curve. Following the Brazilian Association for Technical Standards (ABNT) and copyright rules (lei número 9.610), these parts are identified by quotation marks.


*Isolan GR: A construção do conhecimento pelo jovem neurocirurgião: ética, ciência e a importância do treinamento em laboratório de microcirurgia. J Bras Neurocirurg 20 (3): 314–334, 2009.


This paper, divided in two parts, is a tribute to Professor Evandro de Oliveira, MD, PhD. (1945 - 2021)




Publication History

Received: 29 July 2022

Accepted: 18 August 2022

Article published online:
16 December 2022

© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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