• Abdulrahman J Sabbagh, Khalid M Bajunaid, Norah Alarifi, Alexander Winkler-Schwartz, Ghusn Alsideiri, Gmaan Al-Zhrani, Fahad E Alotaibi, Abdulgadir Bugdadi, Denis Laroche, and Rolando F Del Maestro.
• Division of Neurosurgery, Department of Surgery, Faculty of Medicine and Clinical Skill and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia; Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada. Electronic address: abdulrahman.sabbagh@gmail.com.
• World Neurosurg. 2020 Jul 1; 139: e220-e229.

BackgroundAdvancement and evolution of current virtual reality (VR) surgical simulation technologies are integral to improve the available armamentarium of surgical skill education. This is especially important in high-risk surgical specialties. Such fields including neurosurgery are beginning to explore the utilization of virtual reality simulation in the assessment and training of psychomotor skills. An important issue facing the available VR simulation technologies is the lack of complexity of scenarios that fail to replicate the visual and haptic realities of complex neurosurgical procedures. Therefore there is a need to create more realistic and complex scenarios with the appropriate visual and haptic realities to maximize the potential of virtual reality technology.MethodsWe outline a roadmap for creating complex virtual reality neurosurgical simulation scenarios using a step-wise description of our team's subpial tumor resection project as a model.ResultsThe creation of complex neurosurgical simulations involves integrating multiple modules into a scenario-building roadmap. The components of each module are described outlining the important stages in the process of complex VR simulation creation.ConclusionsOur roadmap of a stepwise approach for the creation of complex VR-simulated neurosurgical procedures may also serve as a guide to aid the development of other VR scenarios in a variety of surgical fields. The generation of new VR complex simulated neurosurgical procedures, by surgeons for surgeons, with the help of computer scientists and engineers may improve the assessment and training of residents and ultimately improve patient care.Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.

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