A Metaverse-Based VR Platform for Objective Neurosurgical Skill Evaluation

Operating-room exposure in neurosurgical training is unevenly distributed. We developed a patient-specific virtual reality (VR) neurosurgical training platform of 20 patient-derived cases spanning aneurysm, meningioma, and trauma, running standalone on a commercial head-mounted display with cloud-based logging, and report its first independent evaluation.

A summative usability test of one case-a convexity meningioma-was conducted under IEC 62366-1 by an institutional medical-device testing center. Fifteen neurosurgeons (2 specialists, 13 residents) were recruited and compensated by the center against pre-specified criteria. Independent assessors classified performance on 20 predefined tasks as Correct Use, Use Error, Close Call, or Use Difficulty, and participants completed two 5-point Likert questionnaires. Groups were compared with Fisher's exact and Mann-Whitney U tests.

All 15 participants completed the protocol without dropout or deviation. Subjective ratings were high (pooled median 4.0/5.0 on both instruments), highest for display refresh, realism, usefulness, and interface consistency. Specialists had fewer flagged tasks than residents on all three metrics-Use Error 2/20 versus 6/20 (p = 0.235), Close Call 1/20 versus 7/20 (p = 0.044), Use Difficulty 0/20 versus 3/20 (p = 0.231)-but no metric survived correction, and the task-level denominator does not scale with group size. The 'Control' domain was lowest and most variable (trainee median 4.0, range 1-5); errors concentrated in instrument selection and bimanual manipulation.

A patient-specific neurosurgical VR platform running standalone on commercial hardware is feasible and was rated favorably by independently recruited evaluators. This pilot characterizes usability and defines engineering targets-instrument manipulation and user control-rather than testing efficacy.