Introduction
Neurosurgery is a vast and complicated surgery that requires proper understanding
and establishment; so, virtual reality (VR) can play an important role in making this
process a bit less complicated. Due to the intricate anatomy of the nervous system,
collaboration of various specialists is required to ensure the safety of patients'
lives.[1] Enhancing the surgical process and mediating the clinical outcomes can prove beneficial
for the neurosurgical goals. The multidisciplinary nature of brain surgery leads to
a minimal success rate compared with other surgeries. It demands advanced practical
skills and vast theoretical knowledge. In this complex field, surgeons are required
to quickly adapt to the evolving environment.[2] Advanced technology is a basic need of this domain. The combination of neuroscience
and technology can prolong the patient's life and maintain the quality. Over the years,
neurosurgery has witnessed more advancements and technologies to mediate this multidisciplinary
domain and improve precision. Digital tools like virtual and augmented reality (VR
and AR) are mostly utilized throughout the preclinical and clinical stages.[3] However, they are distinguished from each other; VR creates 3D environments often
used in surgical planning, preoperative training, and education. While AR is used
mostly in intraoperative real-time navigation and real-world tools with anatomical
overlay. Given the difference, this review solely focuses on VR-assisted neurosurgical
training, planning, and education. VR is a modern computer-based simulation that works
to bring enhancement in the medical field. It creates an immersive and interactive
3D environment for the surgeons to help them deal accurately with surgeries. This
can be applied to all domains in accordance with medicine. The application of VR in
neurosurgery is of immense importance, as it helps in clearing the obstacles that
create a hindrance in conducting this diverse surgery and ensures safety and efficacy.
It mediates the expertise of a neurosurgeon and helps in the accurate planning of
surgery.[4] Virtual advancements further initiate the integrative environment for training the
surgeons using 3D models, accessing tumor margins, and helping in the development
of their skills. It can provide preoperative and postoperative knowledge accurately.
It aids in explaining the procedures to the patients, hence improving patients' satisfaction
and understanding. Virtual environments reduce the risk of biases and time, and offer
risk-free training for the neurosurgeons. The involvement of artificial intelligence
(AI) and robotics further enhances the outcomes. Simulators replicate the real-world
conditions, which allows the surgeons and trainers to practice in an artificial environment.
This VR-based simulator helps in modifying the skills of surgeons through hands-on
practice. Artificial intelligence-based simulators help in rectifying the errors and
tracking the progress over time. It can also assess nontechnical skills like teamwork,
communication, and collaboration, thus improving surgical outcomes.[4]
[5]
[6]
[7]
Materials and Methods
This narrative literature review used data from PubMed, Google Scholar, and the Cochrane
Library using the following keywords: “virtual reality,” “VR in neurosurgery,” “skill
development,” “neurosurgical education,” “patient outcome,” “3d visualization,” “evolution
in neurosurgery,” and “simulators.” Boolean operators (AND, OR) were used to refine
the results. The articles, including RCTs, meta-analyses, and systematic reviews,
only in the English language, were selected from inception up to March 2025. The inclusive
studies focused on VR in surgical rehearsal, along with training, education, and skill
development. The selection criteria did not specify any population or age limit. After
full-text screening, 19 articles were selected that matched the inclusion criteria
and are summarized in [Table 1]. Manual searches of reference lists from relevant reviews and included studies were
also performed to analyze additional literature. The studies primarily dealing with
mixed or augmented reality were excluded to maintain focus on VR. Large language models
such as ChatGPT do not currently satisfy our authorship criteria. It was used to refine
language only.
Table 1
Comparison between traditional and VR-assisted training programs
|
Parameters
|
Traditional training
|
Virtual reality-assisted training
|
|
Risk to patient life
|
Present
|
Absent (safe simulation)
|
|
Feedback quality
|
Depend on the leading person
|
Real-time, on-the-spot detection can be improved
|
|
Cost over time
|
Lower for the short term, higher for the long term
|
Initially much higher, but cost-effective over time
|
|
Skills productivity
|
Variable
|
Standardized
|
|
Learning curvature
|
Depend on real-time experience
|
Repetitive stimulation helps develop more accurate performance
|
Results
Evolution of Virtual Reality and Modernization with Artificial Intelligence
Technological advancement has shaped VR in neurosurgery from its conceptual origin
to the sophisticated state. Early studies trace its evolution: in the 1990s, VR only
explored the 3D models of brain anatomy for preoperative planning, but technology
lacked accuracy. By the late 1990s, the visualization was improved, and surgeons were
able to assess the tumor, blood vessels, and critical areas, enhancing preoperative
simulation and stereotactic imaging. Then, in the early 2000s, the virtual-reality-based
training programs were introduced to establish the comprehensive skills of the surgeons.
The fusion of VR with MRI and CT scans provided valuable insight. By the mid-2000s,
VR was utilized to enhance the preoperative approach, and robotic-assisted surgeries
were initiated.[8]
In 2010, simulators like NeuroTouch provided real-time feedback to surgeons, hence
helping them refine skills and correct errors. The training modules for residents
were replaced by VR rather than cadaver-based learning. By the late 2010s, the small
complex regions of the brain started to be explored with precision by VR-assisted
endoscopic neurosurgery. Moreover, telemedicine and remote surgeries were embraced
by neuroscience in this period.[8]
[9]
Finally, the alarming elevation of AI in the 2020s changed the world's vision of neurosurgery.
AI started to invade VR, giving it a unique combination. AI-assisted simulators have
the ability to project surgical outcomes, offer risk determinations, give feedback,
and modify their response during the process of surgery. Machine learning assists
in the determination of the best methods of conducting surgery, and it minimizes bias.
AI can also enhance brain structure segmentation and reduce the learning time in manual
image processing, as well as human error to a minimum. Surgical planning and decision-making
can be helped with AI through the use of large patient datasets and an optimization
of medical imaging.[10]
[11]
[12]
[13] Last but not least, the remote VR surgeries that can be conducted with 5G should
further enhance the safety and results through further cooperation of the surgery
with telemedicine. This timeline is discussed in [Fig. 1].
Fig. 1 The timeline for the modulation and advancement in VR technology from ages (1990–2020).
Technical Evolution of VR in Neurosurgery: From Hardware Foundations to Real-Time
Simulators
With the further maturity of VR and AI, it itself directly led to the creation of
neurosurgical simulators that provide real-time rehearsal and skill evaluation of
ever greater sophistication. Conceptual building blocks were provided by early simulation
blueprints (e.g., those described by Spicer et al[5]). Expanding on this, such platforms as NeuroTouch came to exist to offer tactile
feedback and objective performance data. Various systematic reviews reveal how these
simulators have become critical in standardizing skills training, as the cadaver-based
learning is being substituted in most programmes.[7]
[14]
[15] Moreover, the possibility of real-time rehearsal in patient-specific settings (such
as that shown by Chugh et al and Dodier et al) indicates how simulation has come to
play a central role in contemporary neurosurgical planning and intraoperative preparation.[16]
[17] Such simulation platform advancements are firmly based in the technical history
of VR, in which sophisticated hardware and software infrastructures have been able
to trigger the creation of more realistic and customizable training environments.
VR application in neurosurgery is greatly dependent on the combination of advanced
hardware and complex software. The use of high-resolution stereoscopic monitors and
3D visualization tools exemplifies how the hardware can be used to improve the spatiotemporal
awareness of such complicated structures as cerebral arteriovenous malformations.[18] Similarly, patient-specific simulators emphasize the role of hardware components,
such as haptic devices and immersive headsets, in the provision of realistic tactile
and visual feedback.[17] There is the development of AI-assisted modules and real-time rehearsal platforms
on the software side of the issue that demonstrates how intelligent algorithms create
accurate anatomical representations, advise decision-making, and enable customizable
surgical simulations.[1]
[16] A combination of these hardware and software developments constitutes the core of
the current era of VR-based training and surgical rehearsal, facilitating the transition
between the traditional cadaver-based training and more convenient, repeatable, and
scalable digital alternatives. Such developments in hardware and software infrastructure
have directly led to the creation of more advanced simulators. The simulator is a
representative of the current VR platforms, converting these technical innovations
into neurosurgical training and planning. Additionally, skill acquisition is the chief
demand for the complexity of neurosurgery. Simulators are valuable tools that create
a risk-free environment for surgeons and help them practice again and again for upgrading
planning, visualization, and technical skills without risk to patients.[7]
[19] The study testing of different simulators revealed that medical students and residents
increased their microsurgical performance scores even during stress caused by sleep
disruption. Although the task duration did not differ substantially, the performance
measures of force control and precision changed dramatically, which shows how simulator
training can perfect sensitive bimanual skills in different conditions.[13] Many simulators have been developed, namely, NeuroTouch, PrecisionOS, Surgical TheaterVR,
ImmersiveTouch, and Touch SurgeryVR, for assisting in realistic surgery and education.
Recent developments in VR focus more on visual fidelity and haptic feedback, where
trainees can even experience the instrument in their hands and the modulation of forces.
Furthermore, patient-specific data in imaging form (MRI, CT, etc.) could now be reconstructed
in the form of informative 3D models that would be used to visualize and plan better
anatomical structures.
VR-Assisted Preoperative Surgical Planning and Skill Rehearsal
Neurosurgery is constantly undergoing advancement and technological reframe. Surgical
planning is significant for initiating the complex surgical process. VR visualizes
the original patient data and converts it into 3D models in order for surgeons to
rehearse the original case before undergoing real-time procedures. This highlights
the relationship between the crucial anatomical structures in the brain. Patient-specific
models like SRP are utilized for this rehearsal purpose. It allows surgeons to practice
different techniques and strategies to determine which one is effective, along with
practicing the planned operation on 3D models to assess the injury site from different
angles and coordinate with each other for timely management. This can greatly improve
decision-making power side by side. Potential challenges can be identified and planned
accordingly. Various platforms improve collaboration and provide more comprehensive
ideas. Also, the feedback haptic controllers can be used to recognize the outcomes.[16] Global disparities in surgical processes can be minimized by virtual-reality-based
tutorials. These are affordable and easy to use.[16]
[20] The high-complexity data of patients before surgery can be analyzed, and the most
appropriate method can be recommended. Risk ratio and recovery rate can be estimated
by VR. Intraoperative uncertainties can be reduced by working on virtual models derived
from MRI and CT scans of patients' data. Medical professionals operating in the field
have exhibited positive perspectives on how VR enhances preoperative preparation activities.[21] Furthermore, the element helps tumor patients by enabling better planning for safe
tumor resection. Through VR, doctors can precisely identify tumors to protect healthy
brain tissue from removal. Research evaluated 60 patients who received scans of CT
angiography and MRI–T1W1 and contrast-enhanced MRI–T1W1 image sequences. Use of the
Dextroscope imaging workstation allowed doctors to view stereoscopic structures according
to CT and MRI data imports. Healthcare professionals conducted a preoperative assessment
by selecting standardized patient images, which became surgical references for surgeons
during their operations.[22]
Moreover, one of the major complexities in neurosurgery is the handling of delicate
instruments and tools for the procedure. As inappropriate instrument handling can
lead to increased surgical time, the surrounding tissues can be damaged and incorrect
placement of cuts, infection risks, discomfort, and recovery issues can develop. VR
helps in the development of fine motor skills and the precise hand–eye coordination
of neurosurgeons, which is a major requirement of microsurgical techniques. Various
instruments with their own specialties are involved in the surgical process of the
brain, including scalpels, forceps, retractors, and special tools for particular procedures.
The development of tactile skills used in handling these surgical tools is recognized
in the training sessions of surgeons, which are abetted by VR and aids in precision.
Practice, refining, and proper handling of surgical instruments are initiated by VR.
VR gives assistance in specific instrument selection before the surgery for a particular
procedure and practicing, refining, and proper handling of that instrument. Moreover,
instrument positioning and the timely usage of correct instruments are also facilitated.
Data-driven feedback helps in improving the skills associated with tool handling.
Guidelines supported by instructions on which instrument is to be used after one,
ensuring effectiveness and sequencing.[11]
[23] Another assessment could be that the risk of bias associated with instruments can
be estimated, which leads to minimizing human errors and improving workflow and efficacy
of procedures. The most pivotal part of VR is related to postoperative outcomes. From
an anatomical point of view, the postoperative imaging can be uploaded to VR, and
it can compare the pre- and post-anatomical differences, informing about the recovery
or complication. The surgeon's skill can be estimated by analyzing the simulator metrics
(precision, error rate, completion time) and his aids in improving and boasting their
abilities. Replaying similar cases postoperatively helps the students to practice
and build strong experience. Research suggests that subjects needed decreased durations
of both postoperative sedation and mechanical ventilation, which indicates VR's positive
influence on recovery courses.[24]
Role of VR in Assisting Education and Training
Through VR, neurosurgery students are allowed to run over complicated procedures in
a threat-free environment. It allows for intermittent surgery practice without the
constraints of cadavers or factual cases by putting on realistic surgical surroundings
and anatomical features. Multiple VR platforms dig out the surgeon's control of the
hands and fashion and deliver real-time feedback. The randomized study found that
3D VR models facilitated faster aneurysm detection and better understanding of spatial
anatomy compared with conventional 2D images, suggesting that VR platforms could become
the preferred method for teaching and training in neurosurgery.[25] The time to detect aneurysms was shorter when using 3D VR compared with 2D images,
with the difference reaching statistical significance for the medical student group.
Most participants (90%) found it easier to detect and describe aneurysms using the
3D VR model compared with 2D images.[1]
In 2021, a study was performed in which 40 patients with meningioma of the anterior
or middle fossa were registered. Twenty patients had preoperative planning and intraoperative
3D navigation performed via operating room, a rehearsal/simulation platform; in contrast,
the other patients (control group) had conventional navigation. The surgical procedure
and outcome for the patient were comprehensively compared between the two groups.[26] There were no variations between the two groups. Both senior and junior surgeons
thought that the operating room was an insightful tool for safely performing certain
challenging neurosurgical procedures, and it allowed trainees to better understand
anatomy and procedures. Additionally, another RCT mentions that with the traditional
imaging systems, it was difficult to visualize complex cerebroarteriovenous malformations.
When the stereoscopic virtual reality display system (SVRDS) was compared with the
conventional computed tomography workstation (CCTW), SVRDS demonstrated a much more
accurate number of structures, such as draining veins and arterial feeders, while
CCTW was seen to miss some of them. This is another significant example of how incorporating
VR could help train neurosurgeons to visualize anatomical structures with much precision
and accuracy.[27]
Another RCT specifically focused on evaluating the role of immersive VR in teaching
neuroanatomy. Although both the groups (experimental and control groups) showed no
such difference in anatomical knowledge, the group that utilized VR was seen to be
more motivated and declared the sessions engaging. Thus, it clearly underscores that
the immersive VR tools significantly led to enhanced motivation and a better experience.
VR technology is showing great promise in improving medical education, skill development,
and training, as highlighted by a randomized controlled trial on treating intracerebral
hemorrhage. The study found that using VR for surgical planning with a stereotactic
surgical planning system (SSPS) cut down the time needed for hemorrhage evacuation
by almost 48% (35.27 hours compared with 67.77 hours) and reduced the number of urokinase
injections by 43% (3.63 vs. 6.40) when stacked against traditional methods. This innovative
technology enhances spatial awareness by providing a three-dimensional view of the
best catheter paths, tailors procedural planning to individual patients, potentially
shortens the learning curve for complex procedures, offers a safe training space for
medical trainees, and supports data-driven decision-making by merging imaging with
planning tools. Another research shows technical improvement in procedural knowledge
of ∼50.2% (effect size [ES]: 0.502; confidence interval [CI]: 0.355–0.649; p < 0.001). Technical skills are boosted by 32.5% (ES: 0.325; CI: −0.482 to −0.167;
p < 0.001), and speed increased by 25% (ES: −0.25; CI: −0.399 to −0.107; p < 0.001). The speed of the task was upgraded by 3.95 times compared with before.[15] The tangible improvements in patient outcomes indicate that VR technology could
also greatly enhance medical education and training programs focused on neurosurgical
techniques, giving practitioners the chance to hone essential skills in a controlled,
virtual setting before stepping into real clinical situations.[28]
[29] The diagnostic capabilities of VR strengthen its ability to deliver improved learning
experiences through interactive medical environments for students and professionals.
Through 3D simulations of complex anatomical structures, medical professionals can
enhance their comprehension and skills while handling models of the cerebral vasculature
found in CAVMs. Neurosurgery requires exact knowledge about spatial relationships
for successful outcomes, so this benefit makes a big difference. Medical students
benefit from VR integration into their curricula because it allows them to learn surgical
procedures while exploring human body variations without needing physical cadavers
or live patients, thus creating a controlled learning space with safety features.
The advancement of technology provides VR with more capabilities to support skill
development through its ability to manufacture genuine personalized scenarios which
customize themselves based on learners' abilities. VR technology shows promise to
establish itself as an essential element in medical teaching methods and operating
readiness training by the following year.[30]
[Table 2] illustrates studies that show the impact of VR on neurosurgery.
Traditional Methods Different from Virtual Reality
Advancements in technology and science can be highlighted using the concept of old
traditional methods of neurosurgery versus the VR-based surgeries. Both of them have
pros and cons. Traditionally, neurosurgery involves theoretical education and training,
cadaver dissection, and experienced surgeons. However, VR has emerged as an innovative
tool to increase the strength of neurosurgery and prevent the risks to human life.
One of the advantages of VR is the accessibility. As in traditional methods of cadaver
arrangement, laboratory settings can be a bit more difficult and challenging, as well
as costly. Cadaver practice is time-limited, whereas VR allows the surgeons to practice
at any time and can provide different, difficult, and rare cases to practice their
skills. Trainees can repeat the process again and again until they are sure about
it. Even a small mistake during neurosurgery can be life-threatening , as it is complex.
Traditional methods can often lead to mistakes because sometimes some surgeries need
practice and experience to be conducted. VR simulators create safer learning environments
by analyzing data and drafting the same real-life situation. Traditional training
involves 2D models, textbooks, and diagrams, which are mostly not understandable.
So the degree of interest is dispersed here. VR technology can offer a more interactive,
eye-catching, and engaging learning environment with three-dimensional learning, which
is far better and more comprehensive than a 2D environment. Hence, it can increase
the students' outcomes.[31]
[32] It can manipulate instruments inside the brain and help in more delicate neural
structures to be dissected easily.[30]
[33] VR helps trainees to learn and refine skills at their own pace rather than relying
on scheduling or availability of cadavers. Another important thing to mention is immediate
feedback beforehand analyzing of any complication that can be cured in an ongoing
process. This is not ensured by traditional practices. Beyond this, VR helps trainees
to improve cognitive functions and to reduce stress conditions, which could be the
result of pressure, and thus enables them to make proper decisions and have spatial
awareness. They train them to handle the stress and pressure in the surgical process
so that none of them might panic in the real-world situation. [Table 1] demonstrates the difference between traditional and VR-assisted programs.
Table 2
Studies conducted to visualize the impact of virtual reality on neurosurgery
|
Study (references)
|
Study design
|
Year
|
Number of participants
|
Key findings
|
|
Fazlollahi et al[12]
|
Randomized clinical trial
|
2022
|
A total of 70 medical students (41 [59%] women and 29 [41%] men) from 4 institutions
were randomized
|
Using an AI-driven teaching system to give metric-grounded feedback in VR simulation
directed to superior skill acquisition and transfer compared with remote expert instruction
with similar cognitive/emotional issues, indicating strong promise for AI-upgraded
surgical education
|
|
Greuter et al[25]
|
Randomized controlled trial comparing educational modalities
|
2021 (August issue)
|
Neurosurgical residents and medical students
|
3D VR significantly enhanced speed in aneurysm spotting, especially among students,
and was greatly preferred with minimum side effects, suggesting VR may improve anatomical
education
|
|
Liu et al[18]
|
Randomized controlled trial (retrospective imaging analysis)
|
2023
|
19 patients with cerebral arteriovenous malformations (AVMs)
|
Stereoscopic virtual reality display systems outperformed conventional CT workstations
by more directly depicting CAVM angioarchitecture and increasing spatial understanding
|
|
Perin et al[26]
|
Randomized clinical trial
|
2021
|
40 patients undergoing surgery for intracranial tumors were enrolled
|
Immersive VR significantly improves a patient's understanding and consent quality
in neurosurgery
|
|
Stepan et al[27]
|
Randomized controlled trial
|
2017
|
66 medical students (33 in both the control and experimental groups)
|
VR group rated enjoyment, understanding, and motivation significantly higher (p < 0.01)
|
|
Ros et al[20]
|
Randomized controlled trial
|
2020
|
173 were included in assessing the immediate learning outcomes and 72 were included
at the 6-mo follow-up
|
Immersive VR tutorial improved both instant literacy and retention in EVD training,
with a large-scale practical application demonstrated
|
|
Wang et al[22]
|
Randomized controlled trial
|
2012
|
60 patients with sellar tumors
|
VR allowed intuitive, anatomically detailed preoperative planning, but lacks quantitative
efficacy metrics
|
|
Patel et al[39]
|
Randomized controlled trial
|
2014
|
20 junior medical students participated. Group A is trained using the ImmersiveTouch haptic VR simulator. Group B received no simulation training
|
Haptic VR simulation significantly improves tactile discrimination skills in surgical
tasks, especially for detecting small objects, compared with no training
|
|
Kockro et al[31]
|
Randomized controlled trial
|
2015
|
169 second-year medical students
|
VR-enhanced lecture was well received by students, indicating high acceptance and
positive experience
|
|
Chugh et al[16]
|
Randomized controlled trial
|
2017
|
40 patients participated in intracranial aneurysm clipping
|
Preoperative surgical rehearsal proved to be statistically significant
|
|
Bekelis et al[35]
|
Randomized controlled trial
|
2017
|
A total of 127 patients were randomized. Mean age: 55 y
|
This showed that cases exposed to preoperative VR had increased satisfaction during
the surgical hassle. Hospitals can produce an immersive setting that minimizes stress
and enhances the perioperative experience
|
|
Ciechanski et al[40]
|
Randomized controlled trial
|
2017
|
22 students consented to participate
|
Skill acquisition in a simulation-based environment may be enhanced by the addition
of tDCS in neurosurgical training
|
|
Davids et al[15]
|
Meta-analysis
|
2021
|
Screened 7,405 studies, with 56 articles meeting criteria for qualitative analysis and 32 included in the meta-analysis
|
Neurosurgical simulation, across varied modalities including VR, is explosively supported
for enhancing knowledge, accuracy, and speed in procedural tasks. The confirmation
is grounded in a robust meta-analysis of 32 studies, including RCTs
|
|
Kirkman et al[7]
|
Systematic review
|
2014
|
28 articles formed the basis of this review
|
The authors show qualitative and quantitative advantages of a range of neurosurgical
simulators but discover significant faults in methodology and design
|
|
Lai et al[41]
|
Validation study
|
2024
|
Trainees from neurosurgery and otolaryngology – head and neck surgery at two Canadian
academic centers
|
This simulation has the potential to improve understanding of the complex anatomic
relations of critical neurovascular structures
|
|
Bolton et al[42]
|
Randomized controlled trial
|
2025
|
Thirty-five participants were recruited for the study.
One participant withdrew due to headaches
|
Feasibility of VR rehabilitation confirmed in study.
The majority engaged with VR from day 2 post-op
|
|
Westarp et al[43]
|
A pilot study
|
2024
|
Ten patients participated in the study.
Mean age: 58 years; 40% female
|
VR-IC rated positively with a mean of 4.22.
Improved understanding of pathology and procedure among patients
|
|
Georgescu et al[44]
|
Protocol randomized control trial
|
2021
|
A minimum of 30 patients in each group.
Adults aged 18–65 after specific surgeries
|
The study aims to test the efficacy of a virtual reality-based intervention for pain
relief after surgery.
The results of the study will assist in the development of evidence-based treatments
|
|
Shao et al[33]
|
Randomized controlled trial
|
2020
|
Thirty clinical undergraduates from the batch of 2016 participated.
Participants were randomly divided into two teaching groups
|
The VR teaching group outperformed the traditional group in assessments.
VR improved understanding of anatomical relationships and surgical methods
|
Impacts of Virtual Reality-Assisted Surgery and Patient Outcomes
VR technology produces substantial changes to medical education and surgical training
processes while assisting with patient satisfaction. The immersive nature of VR technology
helps learners and professionals to develop better anatomical knowledge while improving
their understanding of surgical settings and allowing them to enhance their skills.
It also serves patients well by minimizing their preoperative anxiety and enhancing
their satisfaction with their surgical operation.
Medical students benefit from the implementation of 3D visualization in VR because
it helps them understand complicated human body structures more effectively. Previous
research studies proved that medical students who learnt cerebrovascular anatomy through
VR achieved better spatial understanding than their 2D learning counterparts.[25] Another article also determined VR proved better than CT workstations at allowing
diagnosis of cerebral arteriovenous malformations (AVMs) by enhancing spatial orientation
and detail recognition.[34] Additionally, it provides familiarity with the operating room, as medical students
need virtual surgical training to develop self-assurance and adapt to operating room
procedures in real operating rooms. Medical students who used VR digital surgical
theater tours in simulations reported in the article that their knowledge of OR workflows,
equipment, and ambiance improved, thus reducing their anxiety during clinical rotations.[18] The combination of VR tutorials makes surgical training more efficient by increasing
student engagement in their education. According to research work, students learnt
surgical procedure steps more easily while developing active skills and technical
expertise from risk-free repetition through interactive VR modules.[20]
Studies prove that VR-based interventions improve preoperative education and consent
processes through immersive experiences that lead patients to develop stronger optimism.
Patients undergoing surgery experience widespread preoperative anxiety as a primary
concern that intensifies their surgical experience through increased stress and discomfort.
The research findings proved that immersing patients in VR simulations significantly
cut down preoperative anxiety levels.[35] Medical studies proved augmented reality technology decreases perioperative anxiety
while patients report being more involved and better prepared before procedures.[29] Patient satisfaction serves as the main quality indicator for healthcare services,
while VR technology demonstrates effective improvements in this field. The study conducted
by Bekelis et al established that VR-based preoperative training produces more contented
surgical outcomes compared with conventional preoperative sessions.[35] The interactive capabilities of VR allowed patients to view and understand surgical
steps better, so they achieved higher satisfaction. Surgical preparation requires
patients to grasp both their surgical plan and all associated risks. A research study
proved that 3D VR-assisted informed consent applications helped patients better understand
medical procedures because the interactive models allowed them to visualize anatomical
details and operations, hence increasing their decision-making self-assurance.[26]
Discussion
Limitations and Challenges of Using Virtual Reality
The practical use of VR technology for surgical training and intraoperative guidance
encounters multiple obstructions that hinder its broad-scale adoption, and multiple
limitations are present regarding current data and research gaps that need to be fulfilled
by future studies.
VR-assisted training to demonstrate superior outcomes compared with standard physical
models, while VR-based simulations effectively develop surgical abilities. A study
conducted by Dodier et al evaluated augmented patient-specific intracranial aneurysm
simulators through which VR-based training improved surgical abilities, yet did not
show better outcomes than physical training methods. Therefore, integrative use of
VR training methods with hands-on instruction should replace the concept of full VR
replacement in surgical education.[17] Additionally, extended VR immersion produces two major limitations: visual fatigue
symptoms and motion sickness effects. Users experienced discomfort and dizziness alongside
nausea during VR-based training sessions, according to the research conducted by Dodier
et al.[17] VR systems lose their effectiveness in training applications when used for extended
surgical operations and demanding learning exercises. Receiving realistic haptic feedback
plays a vital role in developing surgical talent, combined with tactile perception,
but VR-assisted training lacks this essential element as a main limitation. Real tissue
feedback cannot be duplicated through VR systems because they fail to recreate tissue
resistance and texture features, thereby making it hard for surgeons to develop precision
skills needed for delicate procedures, based on research findings by Patel et al.[9] The haptic-based VR simulation development has not solved the insufficient capabilities
of existing systems for neurosurgery which relies heavily on tactile sensation in
operations. The integration of VR remains challenging when seeking standard surgical
workflow compatibility. Many medical facilities encounter significant challenges when
implementing VR into surgical practice, according to an article.[3] The implementation of VR technology in operating rooms remains in early stages because
operational accuracy and efficiency, together with instrument compatibility issues,
need to be fixed before it can become a standard procedural tool. Also, the expenses
and lack of ethical considerations are a major hindrance for the proper implementation
of VR. Utilizing VR for surgical procedures requires substantial monetary investment,
making it less accessible to facilities. Literature evidence indicates that developing
VR equipment along with software demands substantial funds, which creates a major
obstacle for institutions running on limited budgets.[3] Continuous upgrading and specialized maintenance personnel together drive long-term
expenses. Proper resolution of ethical and legal challenges related to VR-assisted
surgery must accompany the technical and financial requirements for implementation.
The implementation of VR in medical procedures remains incomplete because healthcare
organizations cannot address patient data safety concerns or demonstrate model accuracy
at all stages, nor clearly define who takes responsibility for VR-related mistakes.
Future development of VR requires laws to ensure secure, ethical, and standard procedures
throughout medical practice.
Although the current studies provide significant insights into immersive technologies
in medical practice and patient care, some limitations must be acknowledged for a
more enhanced clinical approach. The literature reviewed mostly included single-center
studies with small sample sizes, limiting broader implementation and population diversity.
Additionally, participants were from specific backgrounds, such as experienced surgeons
or students, restricting external validation. Also, most of the data are self-reported,
causing risks of bias, especially in measuring outcomes like anxiety reduction or
patient satisfaction. Moreover, a lack of detailed information on randomization, blinding,
and follow-up durations raises concerns about study design strength and data sustainability
over time. There is a notable lack of longitudinal studies that assess long-term retention,
clinical performance, or patient outcomes. Alongside, a narrow range of medical procedures
was examined, making it difficult to generalize findings to other training methodologies
and specialties. The absence of standardized assessment criteria further complicates
direct intervention comparisons. These limitations are shortly discussed in [Fig. 2].
Fig. 2 The benefits, limitations, future aspects, and simulators in a summarized form.
Conclusion
VR has emerged as a crucial tool, demonstrating its capabilities in various aspects
of neurosurgery, ranging from preoperative planning of complex procedures to surgical
training of students. Visualization of anatomical structures offered precision and
accuracy, aiding neurosurgeons. It offers improved instrumental handling, tumor removal,
and enhanced patient satisfaction. The combined impacts of AI and VR, along with 5G
technology, make personalized surgical planning and remote surgeries possible and
demand comprehensive research for refined clinical approaches, as it holds immense
potential to revolutionize neurosurgery. For widespread application of VR into the
neurosurgical field, the critical issues like accessibility, cost, and standard protocols
need to be addressed. Thus, the integration of VR in neurosurgery is an expanding
and evolving field that holds immense potential in the future world.
