Assessing performance in brain tumor resection using a novel virtual reality simulator

Abstract

NeuroTouch is a virtual reality (VR) simulator developed for neurosurgical skill training. Validation demonstrating that the system is useful and reliable is required for formal adoption into training curriculums. Face and content validity have been demonstrated for some neurosurgical simulators, but construct validity remains difficult to establish. A pilot validation study was conducted for a NeuroTouch training exercise. Participants completed the internal resection of a simulated convexity meningioma and filled out questionnaires to provide feedback on the experience. Performance metrics included volume of tissues removed, tool path lengths, duration of excessive forces applied and efficient use of the aspirator. Results were analyzed according to participants' level of training, gender, handedness, surgical experience in meningioma removal and hours/week playing musical instruments or video games. Seventy-two participants (10 medical students, 18 junior residents and 44 senior residents) were enrolled. Analyses demonstrated statistically significant increase in tumor removed and efficiency of ultrasonic aspirator use between medical students and residents, but not between junior and senior residents. After covariate adjustment for the number of meningioma cases operated on, multivariate analysis of the level of training became nonsignificant. Participants judged the exercise appropriate and realistic, desiring use of the system in current training programs. We have conducted a pilot validation study for the NeuroTouch tumor resection scenario and demonstrated for the first time, face, content and construct validity of a VR neurosurgical simulation exercise. Future full-scale studies will be conducted in noncompetitive settings and incorporate expert participants.