Novel External Ventricular Drain Training Improves Procedural Accuracy and Attitudes Towards Virtual Reality

Introduction: The application of virtual reality (VR) to neurosurgery has advanced surgeon strategy, patient understanding, and intraoperative awareness. VR also has the potential to improve neurosurgical training. We aimed to characterize a learning curve for VR external ventricular drain (EVD) placement by measuring procedural efficacy.

Methods: A three-dimensional, 360° VR model of standard neuroanatomical features based on CT (Surgical Theater®) was created and viewable through a VR headset (Oculus Rift). Medical students were recruited, administered a pre-trial survey, and provided standardized orientation. Students completed three trials of VR EVD placement. Tasks included identification of anatomic landmarks, trephination, durotomy, and catheter passage. Distance from the catheter tip to Foramen of Monro was measured, and a post-trial survey was administered. Neurosurgery residents also completed VR EVD placements.

Results: Fifteen students (73% male) with no prior neurosurgical experience and four neurosurgery residents participated. Distance from catheter tip to Foramen of Monro was significantly shorter for residents than student trial 1 (0.91 vs 1.8 cm, p=0.018). Student distances improved significantly from trial 1 to 3 (1.8 cm vs 1.4 cm, p=0.029). By trial 3, there was no significant difference between students and residents (0.91 vs 1.4 cm, p=0.74). Attitudes regarding VR utility generally (p=0.003), for specialty interests (p=0.009), for resident curriculums (p=0.035), for patient consent (p=0.04), and for operative training (p=0.04) significantly improved. Students rated VR depth perception, instrument movement, and haptic feedback as neutral or poor (3.3, 3.3, 2.1, respectively).

Conclusion : Students showed significant improvement in procedural efficacy which may simulate resident experiential learning.