Virtual Reality–Based Simulators for Cranial Tumor Surgery: A Systematic Review

Background

Virtual reality (VR) simulators have become useful tools in various fields of medicine. Prominent uses of VR technologies include assessment of physician skills and presurgical planning. VR has shown effectiveness in multiple surgical specialties, yet its use in neurosurgery remains limited.

Objective

To examine all current literature on VR-based simulation for presurgical planning and training in cranial tumor surgeries and to assess the quality of these studies.

Methods

PubMed and Embase were systematically searched to identify studies that used VR for presurgical planning and/or studies that investigated the use of VR as a training tool from inception to May 25, 2017.

Results

The initial search identified 1662 articles. Thirty-seven full-text articles were assessed for inclusion. Nine studies were included. These studies were subdivided into presurgical planning and training using VR.

Conclusions

Prospects for VR are bright when surgical planning and skills training are considered. In terms of surgical planning, VR has noted and documented usefulness in the planning of cranial surgeries. Further, VR has been central to establishing reproducible benchmarks of performance in relation to cranial tumor resection, which are helpful not only in showing face and construct validity but also in enhancing neurosurgical training in a way not previously examined. Although additional studies are needed to better delineate the precise role of VR in each of these capacities, these studies stand to show the usefulness of VR in the neurosurgery and highlight the need for further investigation.

Introduction

As technology advances and improves, tools used with education and training continue to evolve to incorporate these advances. In medicine, postgraduate surgical training frequently uses virtual reality (VR)-based simulation for both the teaching and assessment of skills. As a new approach, the introduction of VR has been met with popularity and holds exciting prospects for both surgical training and preoperative surgical planning of complex procedures because it allows for patient-specific safe environments in which surgeons may hone their skills without risking patient safety.1, 2 Although VR is already commonplace for many surgical specialties,3, 4, 5 adaptation into neurosurgery has been slow and evidence that outlines its usefulness is scant. Current literature on the topic is limited in scope because studies are largely focused on showing validity of VR and are often small in scale and lack important controls and adequate statistical power, making the use of VR in neurosurgery uncertain.¹

Surgical training is an imperative and central aspect of all surgical education. However, real challenges exist between the balancing of patient safety with the need for surgical training. This issue is acutely apparent throughout the neurosurgical specialty. VR offers a novel and exciting solution to these problems, challenging years of tradition, and bypassing legal and ethical quandaries raised by the need to train future generations and maintain patient safety by permitting trainees to simulate intrasurgical stresses and adverse events in a safe environment, all without any risk to patient safety.⁶ Additional strengths offered by VR include the near limitless opportunities for surgeons and residents alike to train in realistic environments.7, 8, 9, 10, 11 The relative expense of VR-based simulators is lower than the alternative traditional training models, rendering superiority in this respect as well.¹² VR is also adjustable to the trainee's skill level and can provide a unique performance evaluation profile for the individual. Novice trainees can therefore have the difficulty of their sessions reduced or increased depending on their individual learning needs. In addition, the progress of a trainee can be monitored over time, providing useful feedback to help trainees pinpoint areas of potential weakness. When used across programs, VR can be used to compare and certify trainees.¹³ These benefits make VR a likely component of neurosurgical curricula in the future.¹⁴

Throughout neurosurgery, various procedures have been simulated in VR. There are various studies investigating the usefulness of VR for endovascular surgeries, spinal surgeries, ventriculostomies, endoscopic approaches, and tumor resection, as well as core surgical skills.¹ However, to our knowledge, a systematic review of VR-based simulators for training and presurgical planning of cranial tumor surgery has not been completed. Only technical reviews, small studies, and a review of the effect of simulation on broad neurosurgical skill acquisition and surgical performance are available.¹ Our study reviews all currently available literature on VR-based simulators for neurosurgical education or presurgical planning of cranial tumor surgery. Furthermore, we assess the quality of the available literature and provide a basis and direction for future studies of this nature.