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Nowadays, young neurosurgeons need to brush up their skills with lower surgical case volume compared with what senior neurosurgeons have experienced before due to the increasing number of endovascular treatments as well as the trend toward less invasive treatment. To overcome such difficulties, under the instruction of the senior author (KT), the first author underwent suturing training using 10-0 nylon under desktype microscope, accumulating up to 80,000 stitches over the past 8 years. In addition, the junior author (NK, AK, RO) underwent the same training, accumulating up to 10,000-40,000 stitches. The training resulted in the surgeons being able to achieve stable STA-MCA anastomosis under supervision after 10,000 stitches, STA-MCA anastomosis within 20 minutes occlusion time and mastery of aneurysmal clipping of anterior circulation (normal size) after 30,000 stitches, deep anastomosis and clipping of large aneurysm under supervision after 50,000 stitches. After 80,000 stitches, it was possible to manage 280 surgical cases/year institution (clipping, 50; bypass, 30; ICH removal, 30) as a chief. Although there are various factors to improve surgical skills, this simple, daily and long-term training could help overcome the steep learning curve of cerebrovascular surgical skills by improving dexiterity and maneuverability under high magnification.

The Role of 10-0 Suturing Training under Desktype Microscope for the Mastery of Cerebrovascular Surgery: The Effectiveness of 80,000 Stitches