Dual Surgeon Four-Handed Technique for Open Skull Base Surgery: A Technical and Nontechnical Guide and Systematic Review
Bibliographic record
Abstract
Introduction: Interdisciplinary and intradisciplinary collaboration is common in skull base neurosurgery owing to the complex, challenging and potentially arduous tumors that require resection. Four handed setups, techniques and working relationships that are common in endoscopic skull base and other disciplines of neurosurgery can be applied to open skull base resections. Four handed open skull base surgery has been the preferred practice for decades at our institution. While this approach is not novel by any means, there continues to be a scarcity of comprehensive written, technical manuals that outline optimal surgical set up, equipment, specific technique, interpersonal relationships, advantages, disadvantages and complications that can arise. Additional barriers to application of this technique include a lack of objective patient outcome measures. Here we aim to provide a technical and nontechnical guide addressing these areas for four handed skull base techniques from two international academic skull base groups and perform a systematic review of available literature regarding four-handed cranial neurosurgery.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".