The microsurgery laboratory in neurosurgical training

The complexity of the dissection and nerve, vascular, arachnoid, and dural reconstruction techniques faced by neurosurgeons in their daily practice demands microsurgical training in the laboratory. Vascular microanastomosis techniques are essential for cerebral revascularization, the treatment of complex aneurysms, and the resection of some skull base tumors. However, training in microvascular surgery presents the challenge of being difficult to teach intraoperatively, along with the disadvantage of a limited number of clinical cases due to the rise of endovascular procedures. Microsurgical training should be conducted through a structured and supervised program, using validated models of increasing difficulty. For preliminary exercises, synthetic models and ex-vivo biological tissues are useful. Proficiency is achieved by performing microanastomosis (end-to-end and end-to-side) in living animals. In this article, we describe the most suitable models for training neurosurgery residents in the microsurgery laboratory, based on over three decades of our teaching experience in microsurgery.