Virtual reality-based simulation training for ventriculostomy: an evidence-based approach

BACKGROUND: Virtual reality (VR) simulation-based technologies play an important role in neurosurgical resident training. The Congress of Neurological Surgeons (CNS) Simulation Committee developed a simulation-based curriculum incorporating VR simulators to train residents in the management of common neurosurgical disorders. OBJECTIVE: To enhance neurosurgical resident training for ventriculostomy placement using simulation-based training. METHODS: A course-based neurosurgical simulation curriculum was introduced at the Neurosurgical Simulation Symposium at the 2011 and 2012 CNS annual meetings. A trauma module was developed to teach ventriculostomy placement as one of the neurosurgical procedures commonly performed in the management of traumatic brain injury. The course offered both didactic and simulator-based instruction, incorporating written and practical pretests and posttests and questionnaires to assess improvement in skill level and to validate the simulators as teaching tools. RESULTS: Fourteen trainees participated in the didactic component of the trauma module. Written scores improved significantly from pretest (75%) to posttest (87.5%; P \u3c .05). Seven participants completed the ventriculostomy simulation. Significant improvements were observed in anatomy (P \u3c .04), burr hole placement (P \u3c .03), final location of the catheter (P = .05), and procedure completion time (P \u3c .004). Senior residents planned a significantly better trajectory (P \u3c .01); junior participants improved most in terms of identifying the relevant anatomy (P \u3c .03) and the time required to complete the procedure (P \u3c .04). CONCLUSION: VR ventriculostomy placement as part of the CNS simulation trauma module complements standard training techniques for residents in the management of neurosurgical trauma. Improvement in didactic and hands-on knowledge by course participants demonstrates the usefulness of the VR simulator as a training tool. ABBREVIATIONS: CA, Cochran-ArmitageCNS, Congress of Neurological SurgeonsPGY, postgraduate yearVR, virtual reality