The future of neurosurgical training: Role of augmented reality in enhancing skill acquisition and deciphering...

Innovative neurosurgical teaching methods are gaining popularity these days providing a promising alternative to traditional methods. 3D-AR box models provide a realistic environment with good tactile feedback to trainees. The objective of this study was to evaluate the utility of a Hybrid 3D model integrated with augmented reality (AR) for enhancing anatomical understanding during pterional and retromastoid craniotomies.

Our study included 40 neurosurgeons of varying years of experience, who were randomized to either pterional or retromastoid station. They were made to draw craniotomy iterations before and after AR visualization of gold standard which were compared with actual craniotomy the participant did, followed by dural opening. This was followed by intracranial neurovascular structures identification pre and post AR usage. Number of errors made in both the attempts were noted. This was followed by subjective questionnaire.

90 % participants had no previous knowledge about the models. For pterional group the mean improvement in iteration overlap and craniotomy overlap with the gold standard post AR visualization was 10.29 + -6.36 % and 6.69 + -8.83 % respectively while it was 23.97 + -8.97 % and 14.07 + -14.70 % for the retromastoid group. The improvement in overlap of iteration post AR visualisation with the gold standard correlated negatively with experience for both the groups (r = -0.954, p = 0.001 pterional and r = -0.951, p = 0.001 retromastoid). Similarly, improvement in overlap of craniotomy correlated negatively with experience. Median number of errors in intracranial neurovascular structures identification reduced for both the groups post AR visualisation and significant difference was noted on Wilcoxon signed rank test (p = 0.001). As far as subjective analysis was considered, trainees with relatively fewer years of experience were more in favour of the box models and no significant difference existed between both the groups.

Incorporating hybrid 3D AR box models into the neurosurgery curriculum could be beneficial, particularly for newly joined trainees, as a way to enhance their skills before transitioning to the operating room.