title: Usefulness of a Virtual Reality Percutaneous Trigeminal Rhizotomy Simulator in Neurosurgical Training.
abstract: BACKGROUND
  Simulation-based training may be incorporated into neurosurgery in the future.
  
  
  OBJECTIVE
  To assess the usefulness of a novel haptics-based virtual reality percutaneous trigeminal rhizotomy simulator.
  
  
  METHODS
  A real-time augmented reality simulator for percutaneous trigeminal rhizotomy was developed using the ImmersiveTouch platform. Ninety-two neurosurgery residents tested the simulator at American Association of Neurological Surgeons Top Gun 2014. Postgraduate year (PGY), number of fluoroscopy shots, the distance from the ideal entry point, and the distance from the ideal target were recorded by the system during each simulation session. Final performance score was calculated considering the number of fluoroscopy shots and distances from entry and target points (a lower score is better). The impact of PGY level on residents' performance was analyzed.
  
  
  RESULTS
  Seventy-one residents provided their PGY-level and simulator performance data; 38% were senior residents and 62% were junior residents. The mean distance from the entry point (9.4 mm vs 12.6 mm, P = .01), the distance from the target (12.0 mm vs 15.2 mm, P = .16), and final score (31.1 vs 37.7, P = .02) were lower in senior than in junior residents. The mean number of fluoroscopy shots (9.8 vs 10.0, P = .88) was similar in these 2 groups. Linear regression analysis showed that increasing PGY level is significantly associated with a decreased distance from the ideal entry point (P = .001), a shorter distance from target (P = .05), a better final score (P = .007), but not number of fluoroscopy shots (P = .52).
  
  
  CONCLUSIONS
  Because technical performance of percutaneous rhizotomy increases with training, we proposed that the skills in performing the procedure in our virtual reality model would also increase with PGY level, if our simulator models the actual procedure. Our results confirm this hypothesis and demonstrate construct validity.
authors.affiliation: *Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois; ‡Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, Illinois; §ImmersiveTouch, Inc., Westmont, Illinois; ¶Section of Neurosurgery, Department of Surgery, University of Chicago, Chicago, Illinois; ‖Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee.
authors.forename: Sophia F
authors.initials: SF
authors.lastname: Shakur
authors.forename: Cristian J
authors.initials: CJ
authors.lastname: Luciano
authors.forename: Patrick
authors.initials: P
authors.lastname: Kania
authors.forename: Ben Z
authors.initials: BZ
authors.lastname: Roitberg
authors.forename: P Pat
authors.initials: PP
authors.lastname: Banerjee
authors.forename: Konstantin V
authors.initials: KV
authors.lastname: Slavin
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Sorenson
authors.forename: Fady T
authors.initials: FT
authors.lastname: Charbel
authors.forename: Ali
authors.initials: A
authors.lastname: Alaraj
mesh_terms: D002983:Clinical Competence; D003196:Computer Graphics; D003198:Computer Simulation; D003287:Contrast Media / Q000008:administration & dosage; D005471:Fluoroscopy; D006801:Humans; D021621:Imaging, Three-Dimensional; D007396:Internship and Residency; D009493:Neurosurgery / Q000193:education*; D019635:Neurosurgical Procedures / Q000193:education*; D019051:Rhizotomy / Q000193:education* / Q000379:methods; D014276:Trigeminal Nerve / Q000601:surgery*; D014584:User-Computer Interface
chemical_list: D003287:Contrast Media