Intended for healthcare professionals


Operative Skills in Neurosurgery at the Royal College of Surgeons

BMJ 2010; 340 doi: (Published 03 February 2010) Cite this as: BMJ 2010;340:c523
  1. Lalani Dias, year 1 specialty trainee in neurosurgery
  1. 1Charing Cross Hospital, London
  1. lalanidias{at}

Who is it for?

This course is aimed at year 1 to year 3 specialty trainees in neurosurgery or core surgery trainees with an interest in neurosurgery. Many core surgical rotations include a neurosurgery post, and this course is a useful introduction to simple techniques and the operative anatomy of common procedures and approaches. The drill training day is also useful for trainees in ear, nose, and throat (ENT) surgery and orthopaedics as this is solely drill handling, equipment, and familiarisation. A few trainees come from abroad to do the course.

Who runs it?

The course is held at the Royal College of Surgeons in London, the faculty consisting of consultant neurosurgeons from around the country. They give you individual feedback on your skills and tutor you within your group using cadavers for the operative approaches and anatomy. The high speed drill training day is taught mainly by a Medtronic senior clinical specialist with many years’ experience, along with several colleagues from the company who are on hand to go through the exercises with you.

Why do it?

Because this course assumes no prior neurosurgical experience, the exercises are all possible for beginners. It is a great introduction to the basic concepts of spinal and cranial surgery. It’s not only useful for neurosurgical trainees but also ENT, maxillofacial, and junior orthopaedic trainees.

How is the course structured?

Held in the Wolfson Surgical Skills Centre at the Royal College of Surgeons, the course gives each trainee their own workstation for the drill training day with their own equipment, drills, animal cadaver model, and video screen. The spinal and cranial days are on human cadavers (four tutees to one body) and prosected models.

The first day is spent entirely on the use of power tools and drill training. The second day is all spinal, with basics of a range of approaches to cervical, thoracic, and lumbar spine including the operating microscope. The third day is devoted to intracranial surgery. Practical sessions are interspersed with presentations and demonstration training exercises from the faculty, and there are DVD demonstrations on the drill training day.

What areas are covered?

The drill training day is well structured with good progression through the various drill bits (including diamond drills). You start with basic training using cow scapula to get a feel for the different drill instruments drilling through various parts of bone. You drill holes, canals, and your own shapes, and you free rubber bands fed through the bone (simulating nerve roots) without lacerating the band. You then move on to working on sheep thoracic and cervical spine parts doing laminectomies, foraminotomies, corpectomies, discectomies, and whatever other procedures you feel would improve your understanding of anatomy. You then practise on sheep skulls performing burr holes and craniotomies. The last task of the day is to decorticate a raw egg, leaving the membrane intact—very tricky and a good test of the skills learnt during the day.

The second day is spinal day, and this is done using spinal bony models, prosections, and, most usefully, a cadaver. You practise anterior cervical decompression/anterior approach to cervical spine, posterior cervical spine approach, explore the cranio-cervical junction anatomy, and finish with lumbar and thoracic laminectomies. Each session starts with a short lecture, which is followed by demonstrations on bony models. These are followed by the cadaveric dissection. A tutor at each table checks the anatomy and dissection technique. The faculty emphasises the importance of understanding the operative anatomy.

The final day is cranial day. You go through the full variety of approaches starting with pterional and trauma flap, bifrontal craniotomy, posterior fossa approach, and parasagittal flaps. There is a major emphasis on anatomy during the approaches, and time is taken to make sure each tutee has identified relevant cranial nerves, blood vessels, and so on.

How much is it and how do I apply?

At £1100 the course is expensive, but you are getting a fair deal for your money with all the individual equipment and cadaveric specimens. The fee includes a course handbook, lunch, and refreshments. The course is run twice a year (October and April). It gets booked up quickly, with only 16 participants on each course, so it is advisable to book early.

Would I recommend the course?

Absolutely. This course’s focus is on understanding operative anatomy and the concepts underlying approaches to the spine and cranium. It accepts that complete surgical techniques are acquired over years of practice. Learning these key concepts on cadaveric models with the aid of experienced consultants makes learning in the actual operating theatre more purposeful and potentially less risky.

The course takes place in a relaxed and enjoyable environment with the faculty believing that this is the best place to make mistakes and learn from them.

Contact for further information

Contact or phone 020 7869 6300.


  • Competing interests: None declared.

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