title: Man, mind, and machine: the past and future of virtual reality simulation in neurologic surgery.
abstract: OBJECTIVE
  To review virtual reality in neurosurgery, including the history of simulation and virtual reality and some of the current implementations; to examine some of the technical challenges involved; and to propose a potential paradigm for the development of virtual reality in neurosurgery going forward.
  
  
  METHODS
  A search was made on PubMed using key words surgical simulation, virtual reality, haptics, collision detection, and volumetric modeling to assess the current status of virtual reality in neurosurgery. Based on previous results, investigators extrapolated the possible integration of existing efforts and potential future directions.
  
  
  RESULTS
  Simulation has a rich history in surgical training, and there are numerous currently existing applications and systems that involve virtual reality. All existing applications are limited to specific task-oriented functions and typically sacrifice visual realism for real-time interactivity or vice versa, owing to numerous technical challenges in rendering a virtual space in real time, including graphic and tissue modeling, collision detection, and direction of the haptic interface.
  
  
  CONCLUSIONS
  With ongoing technical advancements in computer hardware and graphic and physical rendering, incremental or modular development of a fully immersive, multipurpose virtual reality neurosurgical simulator is feasible. The use of virtual reality in neurosurgery is predicted to change the nature of neurosurgical education, and to play an increased role in surgical rehearsal and the continuing education and credentialing of surgical practitioners.
authors.affiliation: Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA. rrobison@usc.edu
authors.forename: R Aaron
authors.initials: RA
authors.lastname: Robison
authors.forename: Charles Y
authors.initials: CY
authors.lastname: Liu
authors.forename: Michael L J
authors.initials: ML
authors.lastname: Apuzzo
mesh_terms: D000818:Animals; D004503:Education, Medical, Graduate / Q000379:methods / Q000639:trends*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods / Q000639:trends*; D009493:Neurosurgery / Q000295:instrumentation / Q000379:methods / Q000639:trends; D014584:User-Computer Interface