Advances in neurosurgical education: literature review of mixed-reality simulation models and novel mixed-reality spine prototype.

Objective: Mixed-reality (MR) applications provide opportunities for technical rehearsal, education, and estimation of surgical performance without the risk of patient harm. In this study, the authors provide a structured literature review on the current state of MR applications and their effects on neurosurgery training. They also introduce an MR prototype for neurosurgical spine training.

Methods: An extensive review of the literature based on MR, education, and neurosurgery was performed using the MEDLINE, Cochrane, Scopus, and Embase databases from January 1, 2013, to October 5, 2023. The terms used for the search included "augmented reality," "mixed reality," "education," "neurosurgery," and "neurosurgical procedures." After evaluating the results in the literature, the authors designed an MR prototype to investigate the use of 3D models, haptic feedback, and virtual reality (VR) in an educational module for freehand pedicle screw placement training.

Results: Of the 1089 articles found in the databases, 111 duplicate articles were removed, and 978 articles were screened for MR and neurosurgery. Forty articles were selected to explore the relationship between MR environments and neurosurgery. Of these, 25 described cranial MR use, 13 described spine MR use, and 2 described cranial and spine MR training and education modules. The structured review exposed the relationships between MR environments in neurosurgical education, procedures, functional outcomes, novel technologies, and medical training limitations. These studies revealed favorable feedback for MR modules in neurosurgical education, training, and surgical operative outcomes, warranting further investigation to compare MR-based complementary curriculums, standard training methods, and the underlying advantages and disadvantages of MR modules for neurosurgical pedagogy. Based on this literature review, the authors developed an early MR prototype using a 3D model of scoliosis, a surgical tool tracking system, and conductive material for freehand pedicle screw placement.

Conclusions: The technological features, cost-effectiveness, and limitations of MR are currently being adapted to complement education, surgical optimization, and forecasting applications in neurosurgery. An MR surgical spine prototype was developed as a complementary educational tool.