Virtual reality training in neurosurgery: Review of current status and future applications

Abstract

Background:Over years, surgical training is changing and years of tradition are being challenged by legal and ethical concerns for patient safety, work hour restrictions, and the cost of operating room time. Surgical simulation and skill training offer an opportunity to teach and practice advanced techniques before attempting them on patients. Simulation training can be as straightforward as using real instruments and video equipment to manipulate simulated “tissue” in a box trainer. More advanced virtual reality (VR) simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations.Methods:A PubMed review of the literature was performed for the MESH words “Virtual reality, “Augmented Reality”, “Simulation”, “Training”, and “Neurosurgery”. Relevant articles were retrieved and reviewed. A review of the literature was performed for the history, current status of VR simulation in neurosurgery.Results:Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and credential surgeons as technically competent. The number of published literature discussing the application of VR simulation in neurosurgery training has evolved over the last decade from data visualization, including stereoscopic evaluation to more complex augmented reality models. With the revolution of computational analysis abilities, fully immersive VR models are currently available in neurosurgery training. Ventriculostomy catheters insertion, endoscopic and endovascular simulations are used in neurosurgical residency training centers across the world. Recent studies have shown the coloration of proficiency with those simulators and levels of experience in the real world.Conclusion:Fully immersive technology is starting to be applied to the practice of neurosurgery. In the near future, detailed VR neurosurgical modules will evolve to be an essential part of the curriculum of the training of neurosurgeons.

Neurosurgical training programme in selected european countries – from young neurosurgeons point of view

“…Over years, surgical training is changing and years of tradition are being challenged by legal and ethical concerns for patient safety (1). Many factors influence the education policy in neurosurgery, for example the problems in the development or economy of the European national health systems (12,15,29).…”

Ventricular endoscopy in the pediatric population: review of indications

“…Furthermore, neuroendoscopic techniques permit smaller incisions, limit the need for brain retraction, decrease patient discomfort, and improve cosmetic results in pediatric patients [6]. Along with such practice shifts comes the increased emphasis on high-fidelity virtual training, given ventricular endoscopy's steep learning curve [7][8][9][10].…”

Design of a synthetic simulator for pediatric lumbar spine pathologies

“…1,32 Therefore, it is expected that in the near future, surgical simulators will become an integral part of the curriculum of the majority of neurosurgical training programs. 3,12,31,41,49,66 There is already significant Level I evidence demonstrating that technical skills acquired on simulated models directly translate into technical performance in the operating room, enhancing the resident's ability to attend to expected cognitive components of surgical expertise. 31,41 In relation to the role of simulation in surgical education, one important question refers to the manner in which such training might be successfully implemented in the current curriculum of neurosurgical residencies.…”

“…42,50,68 In the past few years, however, new advancements in virtual-reality technology have enabled the design of more refined simulators. 3,17,18,21,33,63 Taking into account the ongoing technical advancements in computer hardware, the development of more complex software for graphic rendering, and the formulation of new paradigms for improving haptic feedback and methods for detection of tissue collision in such models, it is expected that most future simulators in neurosurgery will involve at least some form of virtual reality. 7,9,39,62 Nevertheless, according to a recent review that evaluated the current status of virtual-reality simulation in neurosurgery, all existing applications seem to be limited to some specific task-oriented functions, and, due to numerous technical challenges in rendering a virtual space in real time (including graphic modeling, collision detection, and direction of the haptic interface), typically sacrifice visual realism for real-time interactivity or vice versa.…”