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Background: Simulation-based techniques using three-dimensional models are gaining popularity in neurosurgical training. Most pre-existing models are expensive, so we felt a need to develop a real-life model using 3D printing technology to train in endoscopic third ventriculostomy. Methods: The brain model was made using a 3D-printed resin mold from patient-specific MRI data. The mold was filled with silicone Ecoflex™ 00-10 and mixed with Silc Pig® pigment additives to replicate the color and consistency of brain tissue. The dura mater was made from quick-drying silicone paste admixed with gray dye. The blood vessels were made from a silicone 3D-printed mold based on magnetic resonance imaging. Liquid containing paprika oleoresin dye was used to simulate blood and was pumped through the vessels to simulate pulsatile motion. Results: Seven residents and eight senior neurosurgeons were recruited to test our model. The participants reported that the size and anatomy of the elements were very similar to real structures. The model was helpful for training neuroendoscopic 3D perception and navigation. Conclusions: We developed an endoscopic third ventriculostomy training model using 3D printing technology that provides anatomical precision and a realistic simulation. We hope our model can provide an indispensable tool for young neurosurgeons to gain operative experience without exposing patients to risk.

Cadaveric models remain an essential part of medical training across all specialties. Due to their scarcity, high costs, and possible health hazards, there is a need for more accessible and affordable alternatives, especially in low-resource settings. We introduce cost-effective and easily replicable three-dimensional (3D) printed models to help democratize access to hands-on neuroanatomy education. Silicone-based glue is applied on the surface of a 3D-printed or cadaveric bone frame. Using plastiline on a 3 mm 3D acrylonitrile butadiene styrene pen, the desired anatomical structure is printed on the bone frame. A heat gun is used to smoothen the plastic edges. The structure can then be painted according to its appearance in the real anatomy. Using this technique, we successfully generated a variety of anatomical models to study the cerebrovascular anatomy, the course of the cranial nerves in relation to the skull base, and extracranial structures including the spine. Procurement and conservation of cadaveric specimens can be cumbersome. Our model may be an affordable and easily replicable approach to bridging the gap in anatomy education between low- and high-resource facilities.

Even though neurosurgeons exercise these enormous and versatile skills, the COVID-19 pandemic has shaken the fabrics of the global neurosurgical family, jeopardizing human lives, and forcing the entire world to be locked down. We stand on the shoulders of the giants and will not forget their examples and their teachings. We will work to the best of our ability to honor their memory. Professor Harvey Cushing said: "When to take great risks; when to withdraw in the face of unexpected difficulties; whether to force an attempted enucleation of a pathologically favorable tumor to its completion with the prospect of an operative fatality, or to abandon the procedure short of completeness with the certainty that after months or years even greater risks may have to be faced at a subsequent session-all these require surgical judgment which is a matter of long experience." It is up to us, therefore, to keep on the noble path that we have decided to undertake, to accumulate the surgical experience that these icons have shown us, the fruit of sacrifice and obstinacy. Our tribute goes to them; we will always remember their excellent work and their brilliant careers that will continue to enlighten all of us.