title: Practice on an augmented reality/haptic simulator and library of virtual brains improves residents' ability to perform a ventriculostomy.
abstract: BACKGROUND
  Ventriculostomy is a neurosurgical procedure for providing therapeutic cerebrospinal fluid drainage. Complications may arise during repeated attempts at placing the catheter in the ventricle. We studied the impact of simulation-based practice with a library of virtual brains on neurosurgery residents' performance in simulated and live surgical ventriculostomies.
  
  
  METHODS
  Using computed tomographic scans of actual patients, we developed a library of 15 virtual brains for the ImmersiveTouch system, a head- and hand-tracked augmented reality and haptic simulator. The virtual brains represent a range of anatomies including normal, shifted, and compressed ventricles. Neurosurgery residents participated in individual simulator practice on the library of brains including visualizing the 3-dimensional location of the catheter within the brain immediately after each insertion. Performance of participants on novel brains in the simulator and during actual surgery before and after intervention was analyzed using generalized linear mixed models.
  
  
  RESULTS
  Simulator cannulation success rates increased after intervention, and live procedure outcomes showed improvement in the rate of successful cannulation on the first pass. However, the incidence of deeper, contralateral (simulator) and third-ventricle (live) placements increased after intervention. Residents reported that simulations were realistic and helpful in improving procedural skills such as aiming the probe, sensing the pressure change when entering the ventricle, and estimating how far the catheter should be advanced within the ventricle.
  
  
  CONCLUSIONS
  Simulator practice with a library of virtual brains representing a range of anatomies and difficulty levels may improve performance, potentially decreasing complications due to inexpert technique.
authors.affiliation: Department of Medical Education, College of Medicine, University of Chicago, Chicago, IL 60612, USA. Rachely@uic.edu
authors.forename: Rachel
authors.initials: R
authors.lastname: Yudkowsky
authors.forename: Cristian
authors.initials: C
authors.lastname: Luciano
authors.forename: Pat
authors.initials: P
authors.lastname: Banerjee
authors.forename: Alan
authors.initials: A
authors.lastname: Schwartz
authors.forename: Ali
authors.initials: A
authors.lastname: Alaraj
authors.forename: G Michael
authors.initials: GM
authors.lastname: Lemole
authors.forename: Fady
authors.initials: F
authors.lastname: Charbel
authors.forename: Kelly
authors.initials: K
authors.lastname: Smith
authors.forename: Silvio
authors.initials: S
authors.lastname: Rizzi
authors.forename: Richard
authors.initials: R
authors.lastname: Byrne
authors.forename: Bernard
authors.initials: B
authors.lastname: Bendok
authors.forename: David
authors.initials: D
authors.lastname: Frim
mesh_terms: D001921:Brain / Q000033:anatomy & histology*; D002641:Chicago; D003198:Computer Simulation; D006801:Humans; D008505:Medical Staff, Hospital / Q000193:education; D009493:Neurosurgery / Q000193:education; D011795:Surveys and Questionnaires; D055698:Touch Perception; D014584:User-Computer Interface; D014696:Ventriculostomy / Q000193:education*