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Jeffrey S. Henn, G. Michael Lemole Jr., Mauro A. T. Ferreira, L. Fernando Gonzalez, Mark Schornak, Mark C. Preul and Robert F. Spetzler

education known as ISVR. This imaging platform allows unrivaled demonstration of complex 3D anatomy and relationships. Interactive stereoscopic virtual reality can be used to recreate the experience of neurosurgical approaches much more realistically than standard educational methods. The platform is designed to be inexpensive, widely distributable, easily implemented, and readily scalable. Technical Components of ISVR Interactive stereoscopic virtual reality permits the accurate recreation of neurosurgical approaches through integration of several forms of

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Axel Thomas Stadie, Ralf Alfons Kockro, Robert Reisch, Andrei Tropine, Stephan Boor, Peter Stoeter and Axel Perneczky

leading to it must be generated. The technology to achieve this lies in the realm of what has been called virtual reality that implies: 1) stereoscopic display of the data, and 2) manipulation with 3D tools instead of using a mouse and keyboard. To our knowledge, the only system currently commercially available to accommodate these requirements is the Dextroscope (Volume Interactions, Ltd.), which has been described earlier in a more experimental stage. 17 We have been using this system for the past 3 years to plan a wide variety of neurosurgical procedures related to

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Robin Sawaya, Ghusn Alsideiri, Abdulgadir Bugdadi, Alexander Winkler-Schwartz, Hamed Azarnoush, Khalid Bajunaid, Abdulrahman J. Sabbagh and Rolando Del Maestro

T he NeuroVR (formerly NeuroTouch, CAE Healthcare) virtual reality neurosurgical simulation platform has allowed us to deconstruct and evaluate the surgical performance of “expert” and “novice” participants carrying out virtual reality brain tumor resections. 2–7 , 11 , 12 , 14 , 21 , 23 The performance of neurosurgeon, resident, and medical student groups has been studied using metrics developed by our group. These metrics focus on psychomotor skills such as safety, quality, efficiency, and bimanual dexterity. 2–7 , 23 The recent development of the force

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Clemens Raabe, Jens Fichtner, Jürgen Beck, Jan Gralla and Andreas Raabe

dimensions with biparietal diameters ranging from 132 to 153 mm (mean 143 mm, SD 5.7 mm), frontooccipital diameters ranging from 168 to 210 mm (mean 186 mm, SD 9.9 mm) and a cephalic index (biparietal diameter/frontooccipital diameter × 100) ranging from 70 to 88 (mean 78, SD 4.1). Patients with a hydrocephalic configuration (Evans ratio > 0.3) and/or a mass lesion with displacement of ventricles or midline shift were excluded. The data sets were imported into the planning software of a navigation system (iPlan 3.0, Brainlab) to perform the procedures in virtual reality

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Attila Balogh, Mark C. Preul, Mark Schornak, Michael Hickman and Robert F. Spetzler

-time visualizations recorded from actual neurosurgical procedures. 11, 18 Such technology would permit 3D imaging of surgery for virtual reality-based education—the creation of stereoscopic experiences that include the maneuvers of the surgeon or recordings made during the emergence of surgical problems that are expertly managed. Acknowledgments We thank Carl Zeiss Surgical, Inc., for providing the MKM operating microscope hardware and software support for this project. We also acknowledge Dr. Jeff Henn, a former resident at the Barrow Neurological Institute who is

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P. Pat Banerjee, Cristian J. Luciano, G. Michael Lemole Jr., Fady T. Charbel and Michael Y. Oh

A t the 2006 annual meeting of the AANS, the Young Neurosurgeons Committee organized a surgical competition using three different emerging simulators for residents and fellows in the exhibit hall. Ventriculostomy was one of the techniques tested, 15 and the results of this testing are reported here. The performance of 78 fellows and residents was evaluated for accuracy of ventriculostomy catheter placement using the head- and hand-tracked high-resolution and high-performance virtual reality and haptics workstation known as ImmersiveTouch (ImmersiveTouch

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Zhuo-Ying Du, Xiang Gao, Xiao-Luo Zhang, Zhi-Qiu Wang and Wei-Jun Tang

and results in 47 patients . J Neurosurg 47 : 321 – 328 , 1977 9 Kockro RA , Serra L , Tseng-Tsai Y , Chan C , Yih-Yian S , Gim-Guan C , : Planning and simulation of neurosurgery in a virtual reality environment . Neurosurgery 46 : 118 – 137 , 2000 10 Kockro RA , Stadie A , Schwandt E , Reisch R , Charalampaki C , Ng I , : Virtual reality environment for neurosurgical planning and training . Neurosurgery 61 : 379 – 391 , 2007 11 Kondo A : Follow-up results of microvascular decompression in trigeminal

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Kim Burchiel

Dr. Spetzler, and the group from the Barrow Neurological Institute have long championed the use of high-resolution, three-dimensional (3D) image capture for purposes of illustration and instruction. This modality has been particularly applicable to cerebrovascular surgery. The latest iteration of this work is described in their article titled “Intraoperative stereoscopic QuickTime Virtual Reality,” which appears in this month's Journal of Neurosurgery . Currently, these authors exploit software that is readily available (QuickTime Virtual Reality [QTVR]) to

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Hamed Azarnoush, Samaneh Siar, Robin Sawaya, Gmaan Al Zhrani, Alexander Winkler-Schwartz, Fahad Eid Alotaibi, Abdulgadir Bugdadi, Khalid Bajunaid, Ibrahim Marwa, Abdulrahman Jafar Sabbagh and Rolando F. Del Maestro

result in application of higher tumor forces to locate the tumor in our virtual reality environment. The location of the maximum applied force crescents and intratumor 3D regionality were consistent with our previous findings ( Fig. 3 ). FIG. 6. Force pyramids (3D and top views) for medical student, resident, and neurosurgeon groups for resection of simulated tumors of varying appearance. Each pyramid represents, collectively, the applied forces in Newtons (N) in the xy and xz coordinates of all individuals in each group for the 6 black, glioma-like, and white tumors

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Gerrit Fischer, Axel Stadie, Eike Schwandt, Joachim Gawehn, Stephan Boor, Juergen Marx and Joachim Oertel

subtraction angiography data, remain challenging. In the current study we describe the application of a 3D virtual reality planning system based on 3-T MR angiography and its consequences for preoperative planning and an intraoperative strategy without stereotactic neuronavigation guidance. Methods A 3D virtual reality planning tool (Dextroscope, Volume Interactions, Bracco AMT, Inc.) was applied in 5 consecutive STA-MCA bypass procedures between July and December 2008. The system's influence on the surgical procedure was evaluated with special attention to the