Development of a Novel Pterional Craniotomy Simulator

Introduction: The pterional craniotomy is used to access numerous skull base lesions yet no pterional craniotomy simulators have been designed. Our objective was to design a novel, interactive simulator that users could complete on a mobile device. Additionally, we sought to create a simulator with three-dimensional graphics allowing users to immerse themselves in a realistic environment.

Methods: First, we devised pterional craniotomy protocol and created an animated version of the procedure. Second, we coded software into iOS and Android platforms and built a mobile application, which can currently be downloaded for free in the Apple App or Google Play Store. Third, we designed our module to interact with users using tactile feedback and built it with two user modes: learn and test. Learn mode teaches users how to perform the procedure, containing 132 steps, while test mode assesses procedural knowledge, including 107 multiple-choice questions. User data were prospectively collected from February 2016 to August 2016.

Results: We created a novel, mobile-based pterional simulator for iOS and Android operating systems. The simulator can be downloaded for free and interacts with users via tactile feedback. Fig. 1 (left) demonstrates the initial portion of the craniotomy while Fig. 2 (right) shows how to flatten the anterior cranial fossa floor. Over a 6-month period, 6,393 users from 6 continents (66% North America, 20% Europe, 8% South America, 4% Asia, 1% Africa and 1% Australia) downloaded the module and logged 774 hours of simulation time. The learn and test modes were completed 9,574 and 6,451 times, respectively.

Conclusion: We created the first pterional craniotomy simulator. Our simulator contains high-quality graphics and can be used on any iOS or Android-based mobile device. By extrapolating the current usage rate, we predict ~15,000 more people will download the module over the next 6 months. Given its characteristics, our simulator is widely accessible and ideal for implementation into neurosurgical residency training programs.

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