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Original research
Simulated diagnostic cerebral angiography in neurosurgical training: a pilot program
  1. Alejandro M Spiotta1,2,
  2. Peter A Rasmussen1,2,
  3. Thomas J Masaryk3,
  4. Edward C Benzel1,
  5. Richard Schlenk1
  1. 1Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
  3. 3Division of Neuroradiology, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Alejandro Spiotta, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, S4, Cleveland, OH 44195, USA; aspiotta{at}


Introduction Surgical simulation provides a zero-risk setting in which technical skills can be obtained through repetition. The feasibility and utility of simulated diagnostic cerebral angiography among neurosurgical residents and fellows was studied using an endovascular biplane angiography simulator.

Methods Ten neurosurgical residents and four endovascular neurosurgery fellows were recruited into a standardized training protocol consisting of a didactic, demonstration and hands-on learning environment using the Simbionix simulator. Participants were instructed to catheterize the right internal carotid artery, left internal carotid artery and left vertebral artery. The task was repeated five times.

Results All participants demonstrated improvement over the five trials. Residents performed actions that were perceived as potentially dangerous (n=8) while fellows performed the procedure with superior technique. Residents performed the task with an initial total procedure and fluoroscopy time of 6.6±4.3 min and 4.9±3.7 min, respectively, and improved on the fifth trial to 3.4±1.3 min (p=0.03) and 2.3±0.78 min (p=0.004), respectively. Residents approximated the efficiency of fellows for the third and fourth trial.

Conclusions Incorporating an endovascular simulator is feasible for training purposes in a neurosurgical residency program. This study provides objective documentation of the facilitation of technical angiography skill acquisition by the use of simulation technology.

  • Neurosurgery
  • education
  • simulation
  • angiography
  • hemorrhage
  • fistula
  • arteriovenous malformation
  • intracranial pressure
  • aneurysm
  • economics
  • thrombectomy
  • technique
  • complication
  • catheter
  • balloon
  • thrombolysis
  • stroke
  • stent
  • stenosis
  • malformation
  • intervention
  • embolic
  • device
  • coil
  • atherosclerosis
  • angioplasty

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  • Disclaimer The authors have no financial interest in any of the materials discussed in this manuscript.

  • Competing interests None.

  • Ethics approval Ethics approval was obtained from Cleveland Clinic IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.