Virtual Reality in Neurosurgery- A Neurostimulator – Based Postgraduate Residency Training: A Novel Step Towards Skillful Young Neurosurgeons


  • Usman Ahmad Kamboh
  • Sidra Abid
  • Sana Ullah
  • Mehwish Manzoor
  • Kashif Sultan
  • Mehreen Mehboob et al



VR (virtual reality), Directly Observed Procedural Skills


Introduction/Objective:  Virtual Reality (VR) is the need of time in every field of life. Recent biotechnological advances have molded the surgeon-computer relationship. Department of Neurosurgery Jinnah Hospital Lahore has updated the postgraduate training program by adding the virtual reality simulator. We aim to explore the current and future roles and applications of VR and simulation in neurosurgical training that may reduce the learning curve, improve conceptual understanding and enhance visuospatial skills.

Materials & Methods:  Eight residents were enrolled in this program. They exercised the basic skills of neurosurgery e.g. suction, use of bipolar cautery, handling of CUSA, use of micro scissors, etc., and the automated software recorded each participant’s graph of performance separately. After 1.5 years, they were assessed in real-time on actual patients under the direct supervision of a qualified neurosurgeon. The assessment was done on DOPS (Directly Observed Procedural Skills) Performa.

Results:  The results showed that there was a gradual upward learning curve in simulator-based procedures from negative marking to 70% in basic surgical skills and 60% in advanced procedures on average for all the residents whereas the DOPS showed that all residents performed above expectation i.e., 4 or above.

Conclusion:  Neurostimulator-based postgraduate training program is opening new horizons for the safe and skillful training of residents. With the advancement of artificial intelligence, its use in training programs will lead to structured and systematic training patterns in the world of neurosurgery.


Bernardo A. Virtual Reality and Simulation in Neurosurgical Training. World Neurosurg, 2017; 106: 1015-29.

Kin T, Nakatomi H, Shojima M, Tanaka M, Ino K, Mori H, et al. A new strategic neurosurgical planning tool for brainstem cavernous malformations using interactive computer graphics with multimodal fusion images. J Neurosurg. 2012; 117: 78-88.

Banerjee PP, Luciano CJ, Lemole GM Jr, Charbel FT, Oh MY. Accuracy of ventriculostomy catheter placement using a head- and hand-tracked high-resolution virtual reality simulator with haptic feedback. J Neurosurg. 2007; 107 (3): 515-21.

Clarke DB, D’Arcy RCN, Delorme S, Laroche D, Godin G, Hajra SG, et al. Virtual reality simulator: demonstrated use in neurosurgical oncology. Surg Innov. 2013; 20 (2): 190-7.

Fiani B, De Stefano F, Kondilis A, Covarrubias C, Reier L, Sarhadi K. Virtual reality in neurosurgery: “Can you see it?”—A review of the current applications and future potential. World Neurosurg. 2020; 141: 291-8.

Valdés PA, Roberts DW, Lu F-K, Golby A. Optical technologies for intraoperative neurosurgical guidance. Neurosurg Focus, 2016; 40: E8.

Berguer R: The application of ergonomics in the work environment of general surgeons. Rev Environ Health, 1997; 12: 99-106.

Berguer R: Surgical technology and the ergonomics of laparoscopic instruments. Surg Endosc. 1999; 12: 458-62.

Berguer R, Forkey DL, Smith WD: Ergonomic problems associated with laparoscopic surgery. Surg Endosc. 1999; 13: 466-8.

Mamelak AN, Nobuto T, Berci G. Initial clinical experience with a high-definition exoscope system for microneurosurgery. Neurosurg. 2010; 67: 476-83.

Heath MD, Cohen-Gadol AA. Intraoperative stereoscopic 3D video imaging: pushing the boundaries of surgical visualisation and applications for neurosurgical education. Br J Neurosurg. 2012; 26: 662-667.

Satava RM. Virtual reality surgical simulator. The first steps. Surg Endosc. 1993; 7 (3): 203-205.






Original Articles