Advancing White Matter Knowledge in Neurosurgical Training: Validation and Educational Impact of a Novel 3-Dimensional–Printed Simulator

BACKGROUND: A comprehensive understanding of white matter anatomy is essential for neurosurgical education and surgical planning. Traditional educational tools, including cadaveric dissection, 2-dimensional atlases, and histological preparations, while valuable, have inherent limitations in representing the spatial complexity of white matter architecture. Although microsurgical dissection remains the gold standard, no study to date has specifically evaluated the use of 3-dimensional (3D)-printed simulators focused on white matter tract anatomy as a preparatory learning tool. METHODS: The study involved 17 residents in different years of the neurosurgery residency at Università Cattolica del Sacro Cuore through a structured training program including theoretical sessions, practical dissections using the simulator, and pretraining and post-training assessments. Quantitative improvements were analyzed by comparing knowledge and clinical reasoning scores before and after training. RESULTS: The simulator was perceived as highly realistic and educationally valuable: 81% of participants rated its anatomical accuracy as high or very high. Residents demonstrated significant improvements in clinical reasoning (P = 0.002) and overall test performance (P = 0.005) after training. Specific gains included improved identification of critical white matter tracts at risk during common surgical approaches, enhanced selection of safer trajectories, and better anticipation of intraoperative mapping strategies. The simulator was consistently described as user-friendly and effective in integrating 3D spatial anatomy into surgical decision-making. CONCLUSIONS: This study highlights the utility of 3D-printed simulators in neurosurgical training, offering an accessible platform for learning white matter anatomy. While not a replacement for cadaveric dissections, these simulators provide a complementary tool for early-stage education, bridging the gap between theoretical knowledge and practical application.