Evolving virtual reality simulation in neurosurgery.
BACKGROUND
Virtual reality (VR) applications promise the safe, efficacious, and valid replication of scenarios encountered in modern neurosurgery, and a number of navigation- or dissection-related and endovascular simulators have been successfully deployed in the last 2 decades. Concurrently, neurosurgical training is changing, and VR simulations are expected to play a part in future training.


OBJECTIVE
To give an overview of currently available neurosurgical VR applications in the spectrum of desired applications and the outlook of the requirements to be met by future applications.


METHODS
The available literature was analyzed using structured Medline and PubMed searches. Relevant articles were retrieved and reviewed. When quantitative results were available, effect sizes were collated or estimated to check for publication bias.


RESULTS
There has been a significant increase in publications concerning the use of VR in neurosurgery in the last 22 years (P < .001). Thirty-eight of 117 publications (32%) identified reported data regarding the use of a simulator by practitioners; 35 of these were reported as positive trials (92%). Twenty-two of 38 studies (58%) reported quantitative data with mostly small positive effect sizes (median, 1.41; interquartile range, 1.08-2). The use of VR simulators in endovascular surgery has the most robust basis, with 65% of studies reporting quantitative outcomes.


CONCLUSIONS
Current neurosurgical VR applications focus on basic procedural skill acquisition and are valid and efficacious adjuncts to neurosurgical training. In the future, the development of complex procedural simulators, teamwork, and focus on validated measures will lead to robust framework of the use of VR over the entire career of a neurosurgeon.
*Division of Neurosurgery, Baystate Medical Center, Springfield, Massachusetts; ‡Departments of Neurosurgery and Neurology, Tufts University School of Medicine, Boston, Massachusetts; §Departments of Neurological Surgery and Radiology, Vanderbilt University, Nashville, Tennessee; ¶Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio.
Clemens M
CM
Schirmer
J
J
Mocco
J Bradley
JB
Elder
D002983:Clinical Competence; D003198:Computer Simulation; D004210:Dissection; D057510:Endovascular Procedures / Q000193:education / Q000379:methods; D006801:Humans; D020407:Internet; D038361:Neuronavigation; D009493:Neurosurgery / Q000193:education*; D019635:Neurosurgical Procedures / Q000379:methods*; D017009:Professional Autonomy; D014584:User-Computer Interface