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Oper Neurosurg (Hagerstown). 2017 Feb 1;13(1):89-95. doi: 10.1227/NEU.0000000000001317.

Simulation-based Education for Endoscopic Third Ventriculostomy: A Comparison Between Virtual and Physical Training Models.

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Centre for Image Guided Innovation and Therapeutic Intervention (CIGITI), The Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Neuro-surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Neurosurgery, University Medical Center Groningen, Groningen, the Netherlands.
Division of Clinical Neurological Sci-ences, Western University, London, Ontario, Canada.
SickKids Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
The Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada.
Temerty/Chang International Centre for Telesimulation and Innovation Medical Education, Toronto Western Hospital-University Health Network, Toronto, Ontario, Canada.
Division of General Surgery, Toronto Western Hospital-University Health Network, Toronto, Ontario, Canada.



The relative educational benefits of virtual reality (VR) and physical simulation models for endoscopic third ventriculostomy (ETV) have not been evaluated "head to head."


To compare and identify the relative utility of a physical and VR ETV simulation model for use in neurosurgical training.


Twenty-three neurosurgical residents and 3 fellows performed an ETV on both a physical and VR simulation model. Trainees rated the models using 5-point Likert scales evaluating the domains of anatomy, instrument handling, procedural content, and the overall fidelity of the simulation. Paired t tests were performed for each domain's mean overall score and individual items.


The VR model has relative benefits compared with the physical model with respect to realistic representation of intraventricular anatomy at the foramen of Monro (4.5, standard deviation [SD] = 0.7 vs 4.1, SD = 0.6; P = .04) and the third ventricle floor (4.4, SD = 0.6 vs 4.0, SD = 0.9; P = .03), although the overall anatomy score was similar (4.2, SD = 0.6 vs 4.0, SD = 0.6; P = .11). For overall instrument handling and procedural content, the physical simulator outperformed the VR model (3.7, SD = 0.8 vs 4.5; SD = 0.5, P < .001 and 3.9; SD = 0.8 vs 4.2, SD = 0.6; P = .02, respectively). Overall task fidelity across the 2 simulators was not perceived as significantly different.


Simulation model selection should be based on educational objectives. Training focused on learning anatomy or decision-making for anatomic cues may be aided with the VR simulation model. A focus on developing manual dexterity and technical skills using endoscopic equipment in the operating room may be better learned on the physical simulation model.


Medical education; Neuroendoscopy; Neurosurgery; Simulation; Surgical evaluation; Surgical training; Virtual reality

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