Background: Neurosurgeons require training in skull-based approaches. Recent technological developments
have led to widespread use of computer-based surgical education and training. However,
it is still difficult to provide detailed and realistic training such as cadaver dissection.
This study introduces a novel training environment using primitive polygon-based microanatomical
3D computer graphics (PPM-3DCG) and evaluates its effectiveness against traditional
patient-image-based 3D computer graphics (PI-3DCG) for skull base surgery.
Objective: This article aims to evaluate the learning effectiveness of the PPM-3DCG in skull
base approach training and the impact of immersive virtual reality (VR) goggles in
this new training method.
Methods: High-resolution polygonal models, representing microanatomical structures up to the
resolution limit of patient-based medical images, were developed and integrated into
a VR training application. This training method was defined as PPM-3DCG training.
As a control, an expert created 3D computer graphics from normal patient images and
integrated it into the same VR training application. This method is referred to as
PI-3DCG training. Ten neurosurgeons engaged in endoscopic pituitary surgery and anterior
petrosal approach (APA) training using both methods on a computer display. The anatomical
accuracy, clarity of surgical landmarks, and realism were assessed using a Likert
scale. Next, the same surgical approaches were performed in the PPM-3DCG training
environment via VR goggles, and the immersion, realism, usability, comfort, and educational
value were compared with those of a computer display.
Results: In PPM-3DCG training, both approaches had higher scores on all measures, with significantly
higher scores for anatomical accuracy and realism. The VR goggles had significantly
higher immersion and educational value scores than regular displays.
Conclusion: PPM-3DCG training, particularly when combined with VR goggles, offers a superior
training platform for skull base surgeries. This pilot study underscores the potential
of this new training environment to revolutionize neurosurgical education and sets
the stage for broader comparative investigations.
