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Published on: November 24, 2014
Measuring competence development for performing high flow extracranial-to-intracranial bypass
Sheau Fung Sia1, Leon Lai, Michael Kerin Morgan
1Department of Neurosurgery, The Australian School of Advanced Medicine, 2 Technology Place, Macquarie University, North Ryde, New South Wales 2109, Australia.
Summary
High flow extracranial-to-intracranial (HF EC-IC) bypass surgery is rarely performed, challenging surgical skill development. Novel training methods like simulation are needed to maintain competence in this complex procedure.
Area of Science:
- Neurosurgery
- Vascular Surgery
Background:
- High flow extracranial-to-intracranial (HF EC-IC) bypass surgery is infrequently performed, posing challenges for surgical competence development.
- Assessing surgical outcomes and complication rates is crucial for rare, complex procedures.
Purpose of the Study:
- To evaluate the incidence of HF EC-IC bypass surgery nationally and assess institutional experience with graft complications and surgical outcomes.
- To identify challenges in maintaining surgical competence for infrequent, high-risk procedures.
Main Methods:
- Reviewed the National Hospital Morbidity Database for national EC-IC bypass incidence.
- Analyzed a prospectively collected institutional database of 170 HF EC-IC bypass cases.
- Recorded graft complications, modified Rankin Scale (mRS) scores >2, and intraoperative cross-clamping times.
Main Results:
- The national EC-IC bypass rate averaged 1.9 cases per 1,000,000 population annually.
- Institutional HF EC-IC bypass was associated with a 14.7% graft complication rate.
- Graft-specific complications leading to mRS >2 occurred in 5.9% of cases, with an average cross-clamping time of 44 minutes.
Conclusions:
- HF EC-IC bypass is a rare procedure that challenges surgical competence development.
- There is a need for innovative training strategies, including simulation and laboratory experience, to maintain surgical skills for HF EC-IC bypass.
