• Alan R Cohen, Subash Lohani, Sunil Manjila, Suriya Natsupakpong, Nathan Brown, and M Cenk Cavusoglu.
• Minimally Invasive Neurosurgery Laboratory, Department of Neurosurgery, Boston Children's Hospital, Boston, MA, USA. alan.cohen@childrens.harvard.edu
• Childs Nerv Syst. 2013 Aug 1;29(8):1235-44.

IntroductionVirtual reality simulation is a promising alternative to training surgical residents outside the operating room. It is also a useful aide to anatomic study, residency training, surgical rehearsal, credentialing, and recertification.DiscussionSurgical simulation is based on a virtual reality with varying degrees of immersion and realism. Simulators provide a no-risk environment for harmless and repeatable practice. Virtual reality has three main components of simulation: graphics/volume rendering, model behavior/tissue deformation, and haptic feedback. The challenge of accurately simulating the forces and tactile sensations experienced in neurosurgery limits the sophistication of a virtual simulator. The limited haptic feedback available in minimally invasive neurosurgery makes it a favorable subject for simulation.ConclusionsVirtual simulators with realistic graphics and force feedback have been developed for ventriculostomy, intraventricular surgery, and transsphenoidal pituitary surgery, thus allowing preoperative study of the individual anatomy and increasing the safety of the procedure. The authors also present experiences with their own virtual simulation of endoscopic third ventriculostomy.

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