Purpose The treatment of cerebral aneurysms shifted from microsurgical to endovascular therapy. But for some difficult aneurysm configurations, e.g. wide neck aneurysms, microsurgical clipping is better suited. From this combination of limited interventions and the complexity of these cases, the need for improved training possibilities for young neurosurgeons arises. Method We designed and implemented a clipping simulation that requires only a monoscopic display, mouse and keyboard. After a virtual craniotomy, the user can apply a clip at the aneurysm which is deformed based on a mass–spring model. Additionally, concepts for visualising distances as well as force were implemented. The distance visualisations aim to enhance spatial relations, improving the navigation of the clip. The force visualisations display the force acting on the vessel surface by the applied clip. The developed concepts include colour maps and visualisations based on rays, single objects and glyphs. Results The concepts were quantitatively evaluated via an online survey and qualitatively evaluated by a neurosurgeon. Regarding force visualisations, a colour map is the most appropriate concept. The necessity of distance visualisations became apparent, as the expert was unable to estimate distances and to properly navigate the clip. The distance rays were the only concept supporting the navigation appropriately. Conclusion The easily accessible surgical training simulation for aneurysm clipping benefits from a visualisation of distances and simulated forces.

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Purpose Intracranial aneurysms can be treated micro-surgically. This procedure involves an appropriate head position of the patient and a proper craniotomy. These steps enable a proper access, facilitating the subsequent steps. To train the access planning process, we propose a VR-based training system. Method We designed and implemented an immersive VR access simulation, where the user is surrounded by a virtual operating room, including medical equipment and virtual staff. The patient’s head can be positioned via hand rotation and an arbitrary craniotomy contour can be drawn. The chosen access can be evaluated by exposing the aneurysm using a microscopic view. Results The evaluation of the simulation took place in three stages: testing the simulation using the think-aloud method, conducting a survey and examining the precision of drawing the contour. Although there are differences between the virtual interactions and their counterparts in reality, the participants liked the immersion and felt present in the operating room. The calculated surface dice similarity coefficient, Hausdorff distance and feedback of the participants show that the difficulty of drawing the craniotomy is appropriate. Conclusion The presented training simulation for head positioning and access planning benefits from the immersive environment. Thus, it is an appropriate training for novice neurosurgeons and medical students with the goal to improve anatomical understanding and to become aware of the importance of the right craniotomy hole.

7T TOF MRI scans provide high resolution images of intracranial vasculature. When segmented, the Circle of Willis is detailed and thus opens up new possibilities, in research but also in education. We propose a segmentation pipeline for the Circle ofWillis, and introduce a prototype that enables exploration of not just the entire Circle of Willis, but also of its centerline, in an immersive VR enviroment. In our prototype, the model can be freely rotated, placed and scaled. A qualitative evaluation was performed with two experienced neuroradiologists, who rated the prototype and its potential positively.

Training clipping of intracranial aneurysms is challenging due to less frequent interventions because of minimalinvasive methods, ethical aspects regarding cadaver training and consumption of resources when using 3D printed models. By proposing an immersive virtual reality training system, we make use of increased motivation, engagement and realism when using a virtual operating room. In this simulation, a selected microsurgical clip can be applied at the aneurysm neck. Before closing the clip and deforming the vessels, the affected area is visualized to assess the clip position. Our qualitative evaluation with two neurosurgeons with different levels of experience indicates benefits such as increased motivation, presence, and the possibility to try out different strategies. However, some surgical steps can be refined to increase realism and learning effect, and interactions can be further improved. The proposed training system benefits from training by trial and error in an engaging environment leading to an improved training experience.