Initial Report on the Nexus Online Case-Based Neurosurgical Education Platform

Background The adoption of electronic learning, such as surgical case modules, has shown to be an effective tool for improving knowledge and skills for trainees in general surgery and surgical subspecialties. However, the field of neurosurgery has largely yet to develop and utilize surgical case modules as a part of surgical education. The goal of the NEXUS project is to develop a comprehensive online library of neurosurgical cases with intraoperative videos and/or photos to better prepare trainees for the operating room. Such a program has potential to significantly improve trainee preparation, knowledge, and surgical skills.

Methods The initial call for curated neurosurgical case modules occurred in February 2017. Authors use a standardized template consisting of summary, case presentation, approach, alternatives, incision, operation, post-op, outcome, pearls and pitfalls, discussion, and links. Authors are encouraged to include video and/or photographs to detail the surgical procedure. Cases undergo peer-review and revisions prior to being accepted for online publication. On the NEXUS Web site, cases are assigned to the following categories: spine, tumor, vascular, trauma, pediatric, functional/epilepsy, and pain. Each category is further subdivided into several subcategories, for example, tumor: skull base, pineal, dural-based, intrinsic, intraventricular, extra-axial, or intra-axial. All cases are in the English language, and are formatted to be viewed on a variety of platforms such as computer, tablet, and smartphone.

Results NEXUS has received 173 case submissions for online publication as of September 2017. Submissions are from 48 unique institutions in the United States, Canada, and Brazil. Cases have been submitted for each neurosurgical subdiscipline, with spine (75 cases), and vascular (68 cases) receiving the most submissions. The number of cases in the other categories are tumor (14), trauma (6), functional/epilepsy (6), pediatrics (2), and pain (2). Cases are highly visual, and include pre- and post-op imaging, anatomic figures, and intraoperative photos and/or videos. Thirty percent of cases include intraoperative video, 43% include intraoperative photos, and 65% include intraoperative photos, video, or both.

Conclusion Since its inception, NEXUS has successfully received cases spanning all neurosurgical subdisciplines and from a variety of institutions. Yet, there is still a need for additional pediatric and pain cases. Furthermore, as not all cases include intraoperative videos or photos, new cases that include such valuable multimedia content would strengthen the repository. Once launched publicly, the NEXUS online neurosurgical repository has the potential to improve trainee preparation for the operating room. As neurosurgery is currently behind other surgical disciplines in utilizing surgical case modules in trainee education, NEXUS can fill an important gap in neurosurgical training. Due to its online availability, NEXUS may also serve as an important resource for neurosurgeons and trainees around the world.