title: The role of simulation in neurosurgery.
abstract: OBJECTIVE
  In an era of residency duty-hour restrictions, there has been a recent effort to implement simulation-based training methods in neurosurgery teaching institutions. Several surgical simulators have been developed, ranging from physical models to sophisticated virtual reality systems. To date, there is a paucity of information describing the clinical benefits of existing simulators and the assessment strategies to help implement them into neurosurgical curricula. Here, we present a systematic review of the current models of simulation and discuss the state-of-the-art and future directions for simulation in neurosurgery.
  
  
  METHODS
  Retrospective literature review.
  
  
  RESULTS
  Multiple simulators have been developed for neurosurgical training, including those for minimally invasive procedures, vascular, skull base, pediatric, tumor resection, functional neurosurgery, and spine surgery. The pros and cons of existing systems are reviewed.
  
  
  CONCLUSIONS
  Advances in imaging and computer technology have led to the development of different simulation models to complement traditional surgical training. Sophisticated virtual reality (VR) simulators with haptic feedback and impressive imaging technology have provided novel options for training in neurosurgery. Breakthrough training simulation using 3D printing technology holds promise for future simulation practice, proving high-fidelity patient-specific models to complement residency surgical learning.
authors.affiliation: Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA.
authors.forename: Roberta
authors.initials: R
authors.lastname: Rehder
authors.affiliation: Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Abd-El-Barr
authors.affiliation: Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Hooten
authors.affiliation: Department of Anesthesia, Pediatric Simulator Program Director, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Weinstock
authors.affiliation: Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Madsen
authors.affiliation: Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA. Alan.Cohen@childrens.harvard.edu.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Cohen
mesh_terms: D001927:Brain Diseases / Q000601:surgery; D003198:Computer Simulation; D006801:Humans; D007091:Image Processing, Computer-Assisted; D059906:Neuroimaging; D009493:Neurosurgery / Q000193:education* / Q000379:methods; D019635:Neurosurgical Procedures / Q000193:education*; D010372:Pediatrics
keywords: 3D printing; Duty hours; Neurosurgery; Residency; Simulation; Virtual reality