Augmented reality has been used in neurosurgery to aid in the visualization of lesions, though it has not been widely adopted for simulation-based neurosurgical training. This work aims to determine if augmented reality can improve identification of drill location and drill angle for neurosurgical procedures and to define objective metrics for assessing trainee performance.
An augmented reality visualization system was developed using the Microsoft HoloLens. Trainee performance metrics were defined and validated intra-operatively in fifteen neurosurgical cases by attending neurosurgeons and trainees. Trainee performance in localization of drill location and angle tasks was assessed in a simulated training with augmented reality visualization and compared with two other visualization methods.
The proposed metrics allowed us to significantly differentiate levels of competence between attending neurosurgeons and trainees in identification of drill location with (p = 0.011) and without (p = 0.001) the HoloLens and drill angle with (p = 0.032) the HoloLens. Augmented reality visualization significantly improved trainee performance in localization of drill location (p < 0.001 and p = 0.008) and angle (p < 0.001 and p < 0.001) in comparison to two other visualization methods. Trainees rated augmented reality visualization equally or more helpful compared to the two other visualization methods.
Trainee performance assessment with augmented reality visualization and the proposed performance metrics stands to add practical value to neurosurgical training curricula. This work represents a necessary step in curriculum development in neurosurgical training for the task of drill location and angle localization in a variety of neurosurgical procedures.