Virtual Reality in Education, Surgical Planning and the Operating Room

Virtual Reality (VR) may be most closely associated with the entertainment industry, but it is already being used in the healthcare field to teach students skull base anatomy and prep for surgeries at Mount Sinai. Led by primary investigators Drs. Raj Shrivastava and Alfred Marc Iloreta, as well as co-investigators Drs. Joshua Bederson, Satish Govindaraj and Anthony Del Signore, the “Immersive Virtual Reality as a Teaching Tool for Neuroanatomy” IRB study was the first of its kind evaluating medical students’ aptitude for skull base anatomy, as well as their attitude and motivation toward learning the material. Additionally, using VR in conjunction with the 3D navigational software Surgical Theater, surgeons at the Skull Base Surgery Center are able to more precisely plan complex cases and utilize VR in the operating room.

VR in the Classroom

Images of normal cerebral anatomy were reconstructed from human Digital Imaging and Communications in Medicine (DICOM). We merged computed tomography imaging (CT) and magnetic resonance imaging (MRI) into a 3D VR format, which is compatible with the Oculus Rift VR System. The ventricular system and cerebro-vasculature were highlighted and labeled to formulate an interactive model. The study was performed as a randomized control trial of 66 students (33 in the control and experimental groups) who studied pertinent neuroanatomical structures using either online textbooks or the VR interactive model. Their brain anatomy knowledge, educational experience and motivation were then evaluated. The results demonstrated that there was no significant difference in anatomy knowledge between the two groups on pre and post-intervention and retention quizzes. However, the VR group found the learning experience to be significantly more engaging and useful and scored significantly higher on the motivation assessment.

VR as a Preoperative Planning Tool

Recognizing the complexity and delicate nature of many skull base tumors, VR preoperative planning allows for a more precise planning and one can mitigate the risk for complications. The Skull Base Surgery Center and the Department of Neurosurgery’s Simulation Core teams have taken Surgical Theater’s 3D mapping program to the next level, fusing together multiple scans of patients’ heads and planning surgical pathways prior to the procedures. This not only enables the team to practice the surgery prior to entering the OR, but it also offers clearer insights into the vascular structures that should be avoided when resecting tumors.

VR in the OR

The pathology removed during these surgeries is often tough and fibrous and around very delicate, crucial structures. The more we bring technology into the critical environment of the live surgery, the more accurate we can be. Enhancing operations with more accurate, virtual technology is comparable to having a GPS system in your car improve your efficiency and even safety.

By integrating navigation and simulation, we can now track the position of the microscope and the focal point of the eye pieces, so it follows where the surgeon’s eyes lie. This augments surgeons’ confident and overall, the reality they have during surgery.