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Giselle Coelho, Eberval Gadelha Figueiredo, Nícollas Nunes Rabelo, Manoel Jacobsen Teixeira, and Nelci Zanon

decreasing risks and poor outcomes. 16 The primary goal of this study is to offer a new tool for neurosurgical education that combines virtual and realistic simulation (mixed reality) to create an authentic surgical training environment for craniosynostosis correction (scaphocephaly type). In addition, we validated this new realistic model using experienced surgeons. Methods Study Population Eighteen experienced surgeons with a minimum of 15 years of practice participated in the validation phase of this study (physical model evaluation). Four were craniofacial plastic

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Ye Li, Xiaolei Chen, Ning Wang, Wenyao Zhang, Dawei Li, Lei Zhang, Xin Qu, Weitao Cheng, Yueqiao Xu, Wenjin Chen, and Qiumei Yang

patient, the surgeon can “visualize” the internal structures of the head through the phone lens. 2 A drawback of this method is that the viewing angles are confined to only a fixed direction behind the mobile phone lens, which limits enhancement of the operator’s spatial perception and performance. Mixed-reality technology is a further development that combines augmented reality and virtual reality. It uses digital objects such as holographic projections to provide virtual information in the physical environment, lending immersive realism to users’ experience. The

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Camilo A. Molina, Christopher F. Dibble, Sheng-fu Larry Lo, Timothy Witham, and Daniel M. Sciubba

navigational data on the surgical field. The 2D data provide axial and sagittal projections of the tracked tool trajectory ( Fig. 4 ). The 3D data for 3D segmentation of the bony spine anatomy are overlaid over the real spine in an anatomically matching orientation, location, and size so that the computer spine projection matches the position and size of the real spine ( Fig. 1C ). The mixed-reality 2D and 3D navigational data permit simultaneous visualization of the navigated tool, navigation data, and surgical field—eliminating the distraction and inefficiency of cyclical

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Giselle Coelho, Eduardo Vieira, Jose Hinojosa, and Hans Delye

: Coelho. Supervision: Coelho. Defining video content/format together with corresponding author: Delye. References 1 Coelho G , Warf B , Lyra M , Zanon N . Anatomical pediatric model for craniosynostosis surgical training . Childs Nerv Syst . 2014 ; 30 ( 12 ): 2009 – 2014 . 2 Coelho G , Figueiredo EG , Rabelo NN , . Development and evaluation of a new pediatric mixed-reality model for neurosurgical training . J Neurosurg Pediatr . 2019 ; 24 ( 4 ): 423 – 432 . 3 Hinojosa J , Esparza J , Muñoz MJ . Endoscopic

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Max Schneider, Christian Kunz, Andrej Pal’a, Christian Rainer Wirtz, Franziska Mathis-Ullrich, and Michal Hlaváč

This might improve with future hardware generations such as the HoloLens 2, which features eye tracking ( https://docs.microsoft.com/en-us/windows/mixed-reality/design/eye-tracking ). Some participants raised concerns about slight dizziness and headaches linked to using the system. These are known side effects in relation to using stereoscopic systems and they are well described in the literature. 23 Also, ergonomic aspects such as discomfort of the head and nose caused by wearing an operating room mask together with the HoloLens were mentioned. Conclusions We

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Bruce L. Tai, Anthony C. Wang, Jacob R. Joseph, Page I. Wang, Stephen E. Sullivan, Erin L. McKean, Albert J. Shih, and Deborah M. Rooney

Psychological Testing Washington, DC , American Educational Research Association , 2014 2 Bond TG , Fox CM : Applying the Rasch Model: Fundamental Measurement in the Human Sciences Mahwah, NJ , Lawrence Erlbaum Associates , 2007 3 Bova FJ , Rajon DA , Friedman WA , Murad GJ , Hoh DJ , Jacob RP , : Mixed-reality simulation for neurosurgical procedures . Neurosurgery 73 : Suppl 1 138 – 145 , 2013 4 Das P , Goyal T , Xue A , Kalatoor S , Guillaume D : Simulation training in neurological surgery . Austin J Neurosurg 1

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Randy L. Jensen, Gmaan Alzhrani, John R. W. Kestle, Douglas L. Brockmeyer, Sara M. Lamb, and William T. Couldwell

residency training: defining and raising the bar . Acad Med 82 : 569 – 573 , 2007 7 Bova FJ , Rajon DA , Friedman WA , Murad GJ , Hoh DJ , Jacob RP , : Mixed-reality simulation for neurosurgical procedures . Neurosurgery 73 ( Suppl 1 ): 138 – 145 , 2013 8 Bridges M , Diamond DL : The financial impact of teaching surgical residents in the operating room . Am J Surg 177 : 28 – 32 , 1999 9 Brightwell A , Grant J : Competency-based training: who benefits? Postgrad Med J 89 : 107 – 110 , 2013 10 Brown JS , Collins A

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Bruce L. Tai, Deborah Rooney, Francesca Stephenson, Peng-Siang Liao, Oren Sagher, Albert J. Shih, and Luis E. Savastano

, 2007 4 Bova FJ , Rajon DA , Friedman WA , Murad GJ , Hoh DJ , Jacob RP , : Mixed-reality simulation for neurosurgical procedures . Neurosurgery 73 : Suppl 1 138 – 145 , 2013 5 Bridges M , Diamond DL : The financial impact of teaching surgical residents in the operating room . Am J Surg 177 : 28 – 32 , 1999 6 Bryson EO , Levine AI : The simulation theater: a theoretical discussion of concepts and constructs that enhance learning . J Crit Care 23 : 185 – 187 , 2008 7 Chatzi M , Karvouniaris M , Makris D

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David H. Shin, Kristopher G. Hooten, Brian D. Sindelar, Brian M. Corliss, William R. Y. Carlton Jr., Christopher P. Carroll, Jeffrey M. Tomlin, and W. Christopher Fox

: Department of the Army Headquarters , 2014 ( https://www.army.mil/e2/c/downloads/337951.pdf ) [Accessed October 15, 2018] 9 Grimm J , Johnson K : Saint Louis Center for Sustainment of Trauma and Readiness Skills: a collaborative Air Force-civilian trauma skills training program . J Emerg Nurs 42 : 104 – 107 , 2016 10.1016/j.jen.2015.04.010 26078262 10 Hooten KG , Lister JR , Lombard G , Lizdas DE , Lampotang S , Rajon DA , Mixed reality ventriculostomy simulation: experience in neurosurgical residency . Neurosurgery 10 : 576 – 581

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Daniel R. Cleary, Dominic A. Siler, Nathaniel Whitney, and Nathan R. Selden

( Suppl 1 ): 111 – 115 , 2013 13 Grober ED , Hamstra SJ , Wanzel KR , Reznick RK , Matsumoto ED , Sidhu RS , : The educational impact of bench model fidelity on the acquisition of technical skill: the use of clinically relevant outcome measures . Ann Surg 240 : 374 – 381 , 2004 14 Hooten KG , Lister JR , Lombard G , Lizdas DE , Lampotang S , Rajon DA , : Mixed reality ventriculostomy simulation: experience in neurosurgical residency . Neurosurgery 10 ( Suppl 4 ): 576 – 581 , 2014 15 Joëls M , Pu Z , Wiegert O