Assessing performance of augmented reality-based neurosurgical training

This paper presents a novel augmented reality(AR)-based neurosurgical training simulator which provides a very natural way for surgeons to learn neurosurgical skills.Surgical simulation with bimanual haptic interaction is integrated in this work to provide a simulated environment for users to achieve holographic guidance for pre-operative training.To achieve the AR guidance,the simulator should precisely overlay the 3D anatomical information of the hidden target organs in the patients in real surgery.In this regard,the patient-specific anatomy structures are reconstructed from segmented brain magnetic resonance imaging.We propose a registration method for precise mapping of the virtual and real information.In addition,the simulator provides bimanual haptic interaction in a holographic environment to mimic real brain tumor resection.In this study,we conduct AR-based guidance validation and a user study on the developed simulator,which demonstrate the high accuracy of our AR-based neurosurgery simulator,as well as the AR guidance mode’s potential to improve neurosurgery by simplifying the operation,reducing the difficulty of the operation,shortening the operation time,and increasing the precision of the operation.

Complications of Learning Curve in Supratentorial Intraventricular Region. The Concept of Fast Daily Fresh Cadaver Practice. (Technical Note for Training Method)

Background: The difficulty of learning curve in different microsurgical regions is one of the most challenging factors that affect neurosurgeon’s life. Two of the delicate areas are the suprasellar intraventricular and pontocerebellar region. High level of microsurgery or endoscopic surgery requires virtuosity, which can not be learnt only by assisting. Even among the well skilled neurosurgeons who work in big centers we can often hear “in spite of centralization there are not enough operations available to keep the high level of our skills”. The situation of surgeons working at mid centers is more difficult especially on duties. Methods: Huge number of scientific articles demonstrate the importance of different types of cadaver practice, but always did not pay enough attention to the daily fast fresh cadaver exercises. Focusing on lifelong every day practice we examined the difficulties of learning curve in intraventricular and pontocerebellar region and try to give some useful advice for practicing on fresh cadavers on a daily basis. We offer a simple endovascular fresh cadaver model for practicing. Results: We have performed more than 800 quick (60 - 90 minutes long) routine practice sessions in these two regions during last 18 years. We found that implantation a modelized pathology and removing it by microscopical or endoscopic way without causing injuries to sensitive structures seems to be the most practical way of fast everyday training. Nerves and vascular bypass sutures are also excellent practical method. Conclusions: We have focused on daily fast fresh cadaver practice as a novel training method like used in professional sport and art. After 18 years experience we can state that, for mastering the microsurgery of pontocerebellar and intraventricular region, which is one of the most challenging regions minimum 100 fresh cadaver practice sessions need before performing the operation. We believe this region should be part of fast fresh cadaver microsurgical practice routine programme on daily bases, minimum one time/week/person.