Virtual Reality in Neurosurgery: Advancing Training, Education, and Surgical Planning

Abstract

Virtual reality (VR) is transforming the vast field of neurosurgery by providing realistic and interactive simulations of intricate brain structures. A literature search of PubMed, Google Scholar, and the Cochrane Library using the keywords “virtual reality,” “VR in neurosurgery,” “skill development,” “neurosurgical education,” “patient outcome,” “3D visualisation,” “evolution in neurosurgery,” and “simulators” was performed. The relevant articles, including RCTs, meta-analyses, and systematic reviews and narrative reviews, were considered from inception up to March 2025. This review of existing literature was conducted to explore the evolution, current applications, and future potential of VR in neurosurgery. Emerging in the early 1990s, it lacked accuracy and precision, but now in the 2020s, it provides exceptional benefits to the field. The findings highlight how VR has enhanced the neurosurgical field through various simulators, optimized strategies and planning and decision making, and improved surgical training. Students of neurosurgery can get trained through various 3D models, providing them with a realistic experience of surgical procedures. Moreover, the integration of artificial intelligence (AI) has further refined surgical decision-making, risk evaluation, and real-time adaptability. However, various challenges exist, making VR accessibility limited. High cost, lack of numerous skilled operators, user discomfort, and no proper ethical protocols are critical hindrances that need to be addressed. VR has evolved into a crucial tool for neurosurgical innovation, although ongoing research needs to refine AI-driven models, expand accessibility, and establish standardized protocols for easy adoption across diverse healthcare settings.

Keywords

education - neurosurgery - simulator - surgical planning - virtual reality

Introduction

Neurosurgery is a vast and complicated surgery that requires proper understanding and establishment; so, virtual reality (VR) can play an important role in making this process a bit less complicated. Due to the intricate anatomy of the nervous system, collaboration of various specialists is required to ensure the safety of patients' lives.[1] Enhancing the surgical process and mediating the clinical outcomes can prove beneficial for the neurosurgical goals. The multidisciplinary nature of brain surgery leads to a minimal success rate compared with other surgeries. It demands advanced practical skills and vast theoretical knowledge. In this complex field, surgeons are required to quickly adapt to the evolving environment.[2] Advanced technology is a basic need of this domain. The combination of neuroscience and technology can prolong the patient's life and maintain the quality. Over the years, neurosurgery has witnessed more advancements and technologies to mediate this multidisciplinary domain and improve precision. Digital tools like virtual and augmented reality (VR and AR) are mostly utilized throughout the preclinical and clinical stages.[3] However, they are distinguished from each other; VR creates 3D environments often used in surgical planning, preoperative training, and education. While AR is used mostly in intraoperative real-time navigation and real-world tools with anatomical overlay. Given the difference, this review solely focuses on VR-assisted neurosurgical training, planning, and education. VR is a modern computer-based simulation that works to bring enhancement in the medical field. It creates an immersive and interactive 3D environment for the surgeons to help them deal accurately with surgeries. This can be applied to all domains in accordance with medicine. The application of VR in neurosurgery is of immense importance, as it helps in clearing the obstacles that create a hindrance in conducting this diverse surgery and ensures safety and efficacy. It mediates the expertise of a neurosurgeon and helps in the accurate planning of surgery.[4] Virtual advancements further initiate the integrative environment for training the surgeons using 3D models, accessing tumor margins, and helping in the development of their skills. It can provide preoperative and postoperative knowledge accurately. It aids in explaining the procedures to the patients, hence improving patients' satisfaction and understanding. Virtual environments reduce the risk of biases and time, and offer risk-free training for the neurosurgeons. The involvement of artificial intelligence (AI) and robotics further enhances the outcomes. Simulators replicate the real-world conditions, which allows the surgeons and trainers to practice in an artificial environment. This VR-based simulator helps in modifying the skills of surgeons through hands-on practice. Artificial intelligence-based simulators help in rectifying the errors and tracking the progress over time. It can also assess nontechnical skills like teamwork, communication, and collaboration, thus improving surgical outcomes.[4] [5] [6] [7]

Materials and Methods

This narrative literature review used data from PubMed, Google Scholar, and the Cochrane Library using the following keywords: “virtual reality,” “VR in neurosurgery,” “skill development,” “neurosurgical education,” “patient outcome,” “3d visualization,” “evolution in neurosurgery,” and “simulators.” Boolean operators (AND, OR) were used to refine the results. The articles, including RCTs, meta-analyses, and systematic reviews, only in the English language, were selected from inception up to March 2025. The inclusive studies focused on VR in surgical rehearsal, along with training, education, and skill development. The selection criteria did not specify any population or age limit. After full-text screening, 19 articles were selected that matched the inclusion criteria and are summarized in [Table 1]. Manual searches of reference lists from relevant reviews and included studies were also performed to analyze additional literature. The studies primarily dealing with mixed or augmented reality were excluded to maintain focus on VR. Large language models such as ChatGPT do not currently satisfy our authorship criteria. It was used to refine language only.

Table 1 Comparison between traditional and VR-assisted training programs

Parameters	Traditional training	Virtual reality-assisted training
Risk to patient life	Present	Absent (safe simulation)
Feedback quality	Depend on the leading person	Real-time, on-the-spot detection can be improved
Cost over time	Lower for the short term, higher for the long term	Initially much higher, but cost-effective over time
Skills productivity	Variable	Standardized
Learning curvature	Depend on real-time experience	Repetitive stimulation helps develop more accurate performance

Results

Evolution of Virtual Reality and Modernization with Artificial Intelligence

Technological advancement has shaped VR in neurosurgery from its conceptual origin to the sophisticated state. Early studies trace its evolution: in the 1990s, VR only explored the 3D models of brain anatomy for preoperative planning, but technology lacked accuracy. By the late 1990s, the visualization was improved, and surgeons were able to assess the tumor, blood vessels, and critical areas, enhancing preoperative simulation and stereotactic imaging. Then, in the early 2000s, the virtual-reality-based training programs were introduced to establish the comprehensive skills of the surgeons. The fusion of VR with MRI and CT scans provided valuable insight. By the mid-2000s, VR was utilized to enhance the preoperative approach, and robotic-assisted surgeries were initiated.[8]

In 2010, simulators like NeuroTouch provided real-time feedback to surgeons, hence helping them refine skills and correct errors. The training modules for residents were replaced by VR rather than cadaver-based learning. By the late 2010s, the small complex regions of the brain started to be explored with precision by VR-assisted endoscopic neurosurgery. Moreover, telemedicine and remote surgeries were embraced by neuroscience in this period.[8] [9]

Finally, the alarming elevation of AI in the 2020s changed the world's vision of neurosurgery. AI started to invade VR, giving it a unique combination. AI-assisted simulators have the ability to project surgical outcomes, offer risk determinations, give feedback, and modify their response during the process of surgery. Machine learning assists in the determination of the best methods of conducting surgery, and it minimizes bias. AI can also enhance brain structure segmentation and reduce the learning time in manual image processing, as well as human error to a minimum. Surgical planning and decision-making can be helped with AI through the use of large patient datasets and an optimization of medical imaging.[10] [11] [12] [13] Last but not least, the remote VR surgeries that can be conducted with 5G should further enhance the safety and results through further cooperation of the surgery with telemedicine. This timeline is discussed in [Fig. 1].

Fig. 1 The timeline for the modulation and advancement in VR technology from ages (1990–2020).

Technical Evolution of VR in Neurosurgery: From Hardware Foundations to Real-Time Simulators

With the further maturity of VR and AI, it itself directly led to the creation of neurosurgical simulators that provide real-time rehearsal and skill evaluation of ever greater sophistication. Conceptual building blocks were provided by early simulation blueprints (e.g., those described by Spicer et al[5]). Expanding on this, such platforms as NeuroTouch came to exist to offer tactile feedback and objective performance data. Various systematic reviews reveal how these simulators have become critical in standardizing skills training, as the cadaver-based learning is being substituted in most programmes.[7] [14] [15] Moreover, the possibility of real-time rehearsal in patient-specific settings (such as that shown by Chugh et al and Dodier et al) indicates how simulation has come to play a central role in contemporary neurosurgical planning and intraoperative preparation.[16] [17] Such simulation platform advancements are firmly based in the technical history of VR, in which sophisticated hardware and software infrastructures have been able to trigger the creation of more realistic and customizable training environments. VR application in neurosurgery is greatly dependent on the combination of advanced hardware and complex software. The use of high-resolution stereoscopic monitors and 3D visualization tools exemplifies how the hardware can be used to improve the spatiotemporal awareness of such complicated structures as cerebral arteriovenous malformations.[18] Similarly, patient-specific simulators emphasize the role of hardware components, such as haptic devices and immersive headsets, in the provision of realistic tactile and visual feedback.[17] There is the development of AI-assisted modules and real-time rehearsal platforms on the software side of the issue that demonstrates how intelligent algorithms create accurate anatomical representations, advise decision-making, and enable customizable surgical simulations.[1] [16] A combination of these hardware and software developments constitutes the core of the current era of VR-based training and surgical rehearsal, facilitating the transition between the traditional cadaver-based training and more convenient, repeatable, and scalable digital alternatives. Such developments in hardware and software infrastructure have directly led to the creation of more advanced simulators. The simulator is a representative of the current VR platforms, converting these technical innovations into neurosurgical training and planning. Additionally, skill acquisition is the chief demand for the complexity of neurosurgery. Simulators are valuable tools that create a risk-free environment for surgeons and help them practice again and again for upgrading planning, visualization, and technical skills without risk to patients.[7] [19] The study testing of different simulators revealed that medical students and residents increased their microsurgical performance scores even during stress caused by sleep disruption. Although the task duration did not differ substantially, the performance measures of force control and precision changed dramatically, which shows how simulator training can perfect sensitive bimanual skills in different conditions.[13] Many simulators have been developed, namely, NeuroTouch, PrecisionOS, Surgical TheaterVR, ImmersiveTouch, and Touch SurgeryVR, for assisting in realistic surgery and education. Recent developments in VR focus more on visual fidelity and haptic feedback, where trainees can even experience the instrument in their hands and the modulation of forces. Furthermore, patient-specific data in imaging form (MRI, CT, etc.) could now be reconstructed in the form of informative 3D models that would be used to visualize and plan better anatomical structures.

VR-Assisted Preoperative Surgical Planning and Skill Rehearsal

Neurosurgery is constantly undergoing advancement and technological reframe. Surgical planning is significant for initiating the complex surgical process. VR visualizes the original patient data and converts it into 3D models in order for surgeons to rehearse the original case before undergoing real-time procedures. This highlights the relationship between the crucial anatomical structures in the brain. Patient-specific models like SRP are utilized for this rehearsal purpose. It allows surgeons to practice different techniques and strategies to determine which one is effective, along with practicing the planned operation on 3D models to assess the injury site from different angles and coordinate with each other for timely management. This can greatly improve decision-making power side by side. Potential challenges can be identified and planned accordingly. Various platforms improve collaboration and provide more comprehensive ideas. Also, the feedback haptic controllers can be used to recognize the outcomes.[16] Global disparities in surgical processes can be minimized by virtual-reality-based tutorials. These are affordable and easy to use.[16] [20] The high-complexity data of patients before surgery can be analyzed, and the most appropriate method can be recommended. Risk ratio and recovery rate can be estimated by VR. Intraoperative uncertainties can be reduced by working on virtual models derived from MRI and CT scans of patients' data. Medical professionals operating in the field have exhibited positive perspectives on how VR enhances preoperative preparation activities.[21] Furthermore, the element helps tumor patients by enabling better planning for safe tumor resection. Through VR, doctors can precisely identify tumors to protect healthy brain tissue from removal. Research evaluated 60 patients who received scans of CT angiography and MRI–T1W1 and contrast-enhanced MRI–T1W1 image sequences. Use of the Dextroscope imaging workstation allowed doctors to view stereoscopic structures according to CT and MRI data imports. Healthcare professionals conducted a preoperative assessment by selecting standardized patient images, which became surgical references for surgeons during their operations.[22]

Moreover, one of the major complexities in neurosurgery is the handling of delicate instruments and tools for the procedure. As inappropriate instrument handling can lead to increased surgical time, the surrounding tissues can be damaged and incorrect placement of cuts, infection risks, discomfort, and recovery issues can develop. VR helps in the development of fine motor skills and the precise hand–eye coordination of neurosurgeons, which is a major requirement of microsurgical techniques. Various instruments with their own specialties are involved in the surgical process of the brain, including scalpels, forceps, retractors, and special tools for particular procedures. The development of tactile skills used in handling these surgical tools is recognized in the training sessions of surgeons, which are abetted by VR and aids in precision. Practice, refining, and proper handling of surgical instruments are initiated by VR. VR gives assistance in specific instrument selection before the surgery for a particular procedure and practicing, refining, and proper handling of that instrument. Moreover, instrument positioning and the timely usage of correct instruments are also facilitated. Data-driven feedback helps in improving the skills associated with tool handling. Guidelines supported by instructions on which instrument is to be used after one, ensuring effectiveness and sequencing.[11] [23] Another assessment could be that the risk of bias associated with instruments can be estimated, which leads to minimizing human errors and improving workflow and efficacy of procedures. The most pivotal part of VR is related to postoperative outcomes. From an anatomical point of view, the postoperative imaging can be uploaded to VR, and it can compare the pre- and post-anatomical differences, informing about the recovery or complication. The surgeon's skill can be estimated by analyzing the simulator metrics (precision, error rate, completion time) and his aids in improving and boasting their abilities. Replaying similar cases postoperatively helps the students to practice and build strong experience. Research suggests that subjects needed decreased durations of both postoperative sedation and mechanical ventilation, which indicates VR's positive influence on recovery courses.[24]

Role of VR in Assisting Education and Training

Through VR, neurosurgery students are allowed to run over complicated procedures in a threat-free environment. It allows for intermittent surgery practice without the constraints of cadavers or factual cases by putting on realistic surgical surroundings and anatomical features. Multiple VR platforms dig out the surgeon's control of the hands and fashion and deliver real-time feedback. The randomized study found that 3D VR models facilitated faster aneurysm detection and better understanding of spatial anatomy compared with conventional 2D images, suggesting that VR platforms could become the preferred method for teaching and training in neurosurgery.[25] The time to detect aneurysms was shorter when using 3D VR compared with 2D images, with the difference reaching statistical significance for the medical student group. Most participants (90%) found it easier to detect and describe aneurysms using the 3D VR model compared with 2D images.[1]

In 2021, a study was performed in which 40 patients with meningioma of the anterior or middle fossa were registered. Twenty patients had preoperative planning and intraoperative 3D navigation performed via operating room, a rehearsal/simulation platform; in contrast, the other patients (control group) had conventional navigation. The surgical procedure and outcome for the patient were comprehensively compared between the two groups.[26] There were no variations between the two groups. Both senior and junior surgeons thought that the operating room was an insightful tool for safely performing certain challenging neurosurgical procedures, and it allowed trainees to better understand anatomy and procedures. Additionally, another RCT mentions that with the traditional imaging systems, it was difficult to visualize complex cerebroarteriovenous malformations. When the stereoscopic virtual reality display system (SVRDS) was compared with the conventional computed tomography workstation (CCTW), SVRDS demonstrated a much more accurate number of structures, such as draining veins and arterial feeders, while CCTW was seen to miss some of them. This is another significant example of how incorporating VR could help train neurosurgeons to visualize anatomical structures with much precision and accuracy.[27]

Another RCT specifically focused on evaluating the role of immersive VR in teaching neuroanatomy. Although both the groups (experimental and control groups) showed no such difference in anatomical knowledge, the group that utilized VR was seen to be more motivated and declared the sessions engaging. Thus, it clearly underscores that the immersive VR tools significantly led to enhanced motivation and a better experience. VR technology is showing great promise in improving medical education, skill development, and training, as highlighted by a randomized controlled trial on treating intracerebral hemorrhage. The study found that using VR for surgical planning with a stereotactic surgical planning system (SSPS) cut down the time needed for hemorrhage evacuation by almost 48% (35.27 hours compared with 67.77 hours) and reduced the number of urokinase injections by 43% (3.63 vs. 6.40) when stacked against traditional methods. This innovative technology enhances spatial awareness by providing a three-dimensional view of the best catheter paths, tailors procedural planning to individual patients, potentially shortens the learning curve for complex procedures, offers a safe training space for medical trainees, and supports data-driven decision-making by merging imaging with planning tools. Another research shows technical improvement in procedural knowledge of ∼50.2% (effect size [ES]: 0.502; confidence interval [CI]: 0.355–0.649; p < 0.001). Technical skills are boosted by 32.5% (ES: 0.325; CI: −0.482 to −0.167; p < 0.001), and speed increased by 25% (ES: −0.25; CI: −0.399 to −0.107; p < 0.001). The speed of the task was upgraded by 3.95 times compared with before.[15] The tangible improvements in patient outcomes indicate that VR technology could also greatly enhance medical education and training programs focused on neurosurgical techniques, giving practitioners the chance to hone essential skills in a controlled, virtual setting before stepping into real clinical situations.[28] [29] The diagnostic capabilities of VR strengthen its ability to deliver improved learning experiences through interactive medical environments for students and professionals. Through 3D simulations of complex anatomical structures, medical professionals can enhance their comprehension and skills while handling models of the cerebral vasculature found in CAVMs. Neurosurgery requires exact knowledge about spatial relationships for successful outcomes, so this benefit makes a big difference. Medical students benefit from VR integration into their curricula because it allows them to learn surgical procedures while exploring human body variations without needing physical cadavers or live patients, thus creating a controlled learning space with safety features. The advancement of technology provides VR with more capabilities to support skill development through its ability to manufacture genuine personalized scenarios which customize themselves based on learners' abilities. VR technology shows promise to establish itself as an essential element in medical teaching methods and operating readiness training by the following year.[30] [Table 2] illustrates studies that show the impact of VR on neurosurgery.

Traditional Methods Different from Virtual Reality

Advancements in technology and science can be highlighted using the concept of old traditional methods of neurosurgery versus the VR-based surgeries. Both of them have pros and cons. Traditionally, neurosurgery involves theoretical education and training, cadaver dissection, and experienced surgeons. However, VR has emerged as an innovative tool to increase the strength of neurosurgery and prevent the risks to human life. One of the advantages of VR is the accessibility. As in traditional methods of cadaver arrangement, laboratory settings can be a bit more difficult and challenging, as well as costly. Cadaver practice is time-limited, whereas VR allows the surgeons to practice at any time and can provide different, difficult, and rare cases to practice their skills. Trainees can repeat the process again and again until they are sure about it. Even a small mistake during neurosurgery can be life-threatening , as it is complex. Traditional methods can often lead to mistakes because sometimes some surgeries need practice and experience to be conducted. VR simulators create safer learning environments by analyzing data and drafting the same real-life situation. Traditional training involves 2D models, textbooks, and diagrams, which are mostly not understandable. So the degree of interest is dispersed here. VR technology can offer a more interactive, eye-catching, and engaging learning environment with three-dimensional learning, which is far better and more comprehensive than a 2D environment. Hence, it can increase the students' outcomes.[31] [32] It can manipulate instruments inside the brain and help in more delicate neural structures to be dissected easily.[30] [33] VR helps trainees to learn and refine skills at their own pace rather than relying on scheduling or availability of cadavers. Another important thing to mention is immediate feedback beforehand analyzing of any complication that can be cured in an ongoing process. This is not ensured by traditional practices. Beyond this, VR helps trainees to improve cognitive functions and to reduce stress conditions, which could be the result of pressure, and thus enables them to make proper decisions and have spatial awareness. They train them to handle the stress and pressure in the surgical process so that none of them might panic in the real-world situation. [Table 1] demonstrates the difference between traditional and VR-assisted programs.

Table 2 Studies conducted to visualize the impact of virtual reality on neurosurgery

Study (references)	Study design	Year	Number of participants	Key findings
Fazlollahi et al[12]	Randomized clinical trial	2022	A total of 70 medical students (41 [59%] women and 29 [41%] men) from 4 institutions were randomized	Using an AI-driven teaching system to give metric-grounded feedback in VR simulation directed to superior skill acquisition and transfer compared with remote expert instruction with similar cognitive/emotional issues, indicating strong promise for AI-upgraded surgical education
Greuter et al[25]	Randomized controlled trial comparing educational modalities	2021 (August issue)	Neurosurgical residents and medical students	3D VR significantly enhanced speed in aneurysm spotting, especially among students, and was greatly preferred with minimum side effects, suggesting VR may improve anatomical education
Liu et al[18]	Randomized controlled trial (retrospective imaging analysis)	2023	19 patients with cerebral arteriovenous malformations (AVMs)	Stereoscopic virtual reality display systems outperformed conventional CT workstations by more directly depicting CAVM angioarchitecture and increasing spatial understanding
Perin et al[26]	Randomized clinical trial	2021	40 patients undergoing surgery for intracranial tumors were enrolled	Immersive VR significantly improves a patient's understanding and consent quality in neurosurgery
Stepan et al[27]	Randomized controlled trial	2017	66 medical students (33 in both the control and experimental groups)	VR group rated enjoyment, understanding, and motivation significantly higher (p < 0.01)
Ros et al[20]	Randomized controlled trial	2020	173 were included in assessing the immediate learning outcomes and 72 were included at the 6-mo follow-up	Immersive VR tutorial improved both instant literacy and retention in EVD training, with a large-scale practical application demonstrated
Wang et al[22]	Randomized controlled trial	2012	60 patients with sellar tumors	VR allowed intuitive, anatomically detailed preoperative planning, but lacks quantitative efficacy metrics
Patel et al[39]	Randomized controlled trial	2014	20 junior medical students participated. Group A is trained using the ImmersiveTouch haptic VR simulator. Group B received no simulation training	Haptic VR simulation significantly improves tactile discrimination skills in surgical tasks, especially for detecting small objects, compared with no training
Kockro et al[31]	Randomized controlled trial	2015	169 second-year medical students	VR-enhanced lecture was well received by students, indicating high acceptance and positive experience
Chugh et al[16]	Randomized controlled trial	2017	40 patients participated in intracranial aneurysm clipping	Preoperative surgical rehearsal proved to be statistically significant
Bekelis et al[35]	Randomized controlled trial	2017	A total of 127 patients were randomized. Mean age: 55 y	This showed that cases exposed to preoperative VR had increased satisfaction during the surgical hassle. Hospitals can produce an immersive setting that minimizes stress and enhances the perioperative experience
Ciechanski et al[40]	Randomized controlled trial	2017	22 students consented to participate	Skill acquisition in a simulation-based environment may be enhanced by the addition of tDCS in neurosurgical training
Davids et al[15]	Meta-analysis	2021	Screened 7,405 studies, with 56 articles meeting criteria for qualitative analysis and 32 included in the meta-analysis	Neurosurgical simulation, across varied modalities including VR, is explosively supported for enhancing knowledge, accuracy, and speed in procedural tasks. The confirmation is grounded in a robust meta-analysis of 32 studies, including RCTs
Kirkman et al[7]	Systematic review	2014	28 articles formed the basis of this review	The authors show qualitative and quantitative advantages of a range of neurosurgical simulators but discover significant faults in methodology and design
Lai et al[41]	Validation study	2024	Trainees from neurosurgery and otolaryngology – head and neck surgery at two Canadian academic centers	This simulation has the potential to improve understanding of the complex anatomic relations of critical neurovascular structures
Bolton et al[42]	Randomized controlled trial	2025	Thirty-five participants were recruited for the study. One participant withdrew due to headaches	Feasibility of VR rehabilitation confirmed in study. The majority engaged with VR from day 2 post-op
Westarp et al[43]	A pilot study	2024	Ten patients participated in the study. Mean age: 58 years; 40% female	VR-IC rated positively with a mean of 4.22. Improved understanding of pathology and procedure among patients
Georgescu et al[44]	Protocol randomized control trial	2021	A minimum of 30 patients in each group. Adults aged 18–65 after specific surgeries	The study aims to test the efficacy of a virtual reality-based intervention for pain relief after surgery. The results of the study will assist in the development of evidence-based treatments
Shao et al[33]	Randomized controlled trial	2020	Thirty clinical undergraduates from the batch of 2016 participated. Participants were randomly divided into two teaching groups	The VR teaching group outperformed the traditional group in assessments. VR improved understanding of anatomical relationships and surgical methods

Impacts of Virtual Reality-Assisted Surgery and Patient Outcomes

VR technology produces substantial changes to medical education and surgical training processes while assisting with patient satisfaction. The immersive nature of VR technology helps learners and professionals to develop better anatomical knowledge while improving their understanding of surgical settings and allowing them to enhance their skills. It also serves patients well by minimizing their preoperative anxiety and enhancing their satisfaction with their surgical operation.

Medical students benefit from the implementation of 3D visualization in VR because it helps them understand complicated human body structures more effectively. Previous research studies proved that medical students who learnt cerebrovascular anatomy through VR achieved better spatial understanding than their 2D learning counterparts.[25] Another article also determined VR proved better than CT workstations at allowing diagnosis of cerebral arteriovenous malformations (AVMs) by enhancing spatial orientation and detail recognition.[34] Additionally, it provides familiarity with the operating room, as medical students need virtual surgical training to develop self-assurance and adapt to operating room procedures in real operating rooms. Medical students who used VR digital surgical theater tours in simulations reported in the article that their knowledge of OR workflows, equipment, and ambiance improved, thus reducing their anxiety during clinical rotations.[18] The combination of VR tutorials makes surgical training more efficient by increasing student engagement in their education. According to research work, students learnt surgical procedure steps more easily while developing active skills and technical expertise from risk-free repetition through interactive VR modules.[20]

Studies prove that VR-based interventions improve preoperative education and consent processes through immersive experiences that lead patients to develop stronger optimism. Patients undergoing surgery experience widespread preoperative anxiety as a primary concern that intensifies their surgical experience through increased stress and discomfort. The research findings proved that immersing patients in VR simulations significantly cut down preoperative anxiety levels.[35] Medical studies proved augmented reality technology decreases perioperative anxiety while patients report being more involved and better prepared before procedures.[29] Patient satisfaction serves as the main quality indicator for healthcare services, while VR technology demonstrates effective improvements in this field. The study conducted by Bekelis et al established that VR-based preoperative training produces more contented surgical outcomes compared with conventional preoperative sessions.[35] The interactive capabilities of VR allowed patients to view and understand surgical steps better, so they achieved higher satisfaction. Surgical preparation requires patients to grasp both their surgical plan and all associated risks. A research study proved that 3D VR-assisted informed consent applications helped patients better understand medical procedures because the interactive models allowed them to visualize anatomical details and operations, hence increasing their decision-making self-assurance.[26]

Discussion

Limitations and Challenges of Using Virtual Reality

The practical use of VR technology for surgical training and intraoperative guidance encounters multiple obstructions that hinder its broad-scale adoption, and multiple limitations are present regarding current data and research gaps that need to be fulfilled by future studies.

VR-assisted training to demonstrate superior outcomes compared with standard physical models, while VR-based simulations effectively develop surgical abilities. A study conducted by Dodier et al evaluated augmented patient-specific intracranial aneurysm simulators through which VR-based training improved surgical abilities, yet did not show better outcomes than physical training methods. Therefore, integrative use of VR training methods with hands-on instruction should replace the concept of full VR replacement in surgical education.[17] Additionally, extended VR immersion produces two major limitations: visual fatigue symptoms and motion sickness effects. Users experienced discomfort and dizziness alongside nausea during VR-based training sessions, according to the research conducted by Dodier et al.[17] VR systems lose their effectiveness in training applications when used for extended surgical operations and demanding learning exercises. Receiving realistic haptic feedback plays a vital role in developing surgical talent, combined with tactile perception, but VR-assisted training lacks this essential element as a main limitation. Real tissue feedback cannot be duplicated through VR systems because they fail to recreate tissue resistance and texture features, thereby making it hard for surgeons to develop precision skills needed for delicate procedures, based on research findings by Patel et al.[9] The haptic-based VR simulation development has not solved the insufficient capabilities of existing systems for neurosurgery which relies heavily on tactile sensation in operations. The integration of VR remains challenging when seeking standard surgical workflow compatibility. Many medical facilities encounter significant challenges when implementing VR into surgical practice, according to an article.[3] The implementation of VR technology in operating rooms remains in early stages because operational accuracy and efficiency, together with instrument compatibility issues, need to be fixed before it can become a standard procedural tool. Also, the expenses and lack of ethical considerations are a major hindrance for the proper implementation of VR. Utilizing VR for surgical procedures requires substantial monetary investment, making it less accessible to facilities. Literature evidence indicates that developing VR equipment along with software demands substantial funds, which creates a major obstacle for institutions running on limited budgets.[3] Continuous upgrading and specialized maintenance personnel together drive long-term expenses. Proper resolution of ethical and legal challenges related to VR-assisted surgery must accompany the technical and financial requirements for implementation. The implementation of VR in medical procedures remains incomplete because healthcare organizations cannot address patient data safety concerns or demonstrate model accuracy at all stages, nor clearly define who takes responsibility for VR-related mistakes. Future development of VR requires laws to ensure secure, ethical, and standard procedures throughout medical practice.

Although the current studies provide significant insights into immersive technologies in medical practice and patient care, some limitations must be acknowledged for a more enhanced clinical approach. The literature reviewed mostly included single-center studies with small sample sizes, limiting broader implementation and population diversity. Additionally, participants were from specific backgrounds, such as experienced surgeons or students, restricting external validation. Also, most of the data are self-reported, causing risks of bias, especially in measuring outcomes like anxiety reduction or patient satisfaction. Moreover, a lack of detailed information on randomization, blinding, and follow-up durations raises concerns about study design strength and data sustainability over time. There is a notable lack of longitudinal studies that assess long-term retention, clinical performance, or patient outcomes. Alongside, a narrow range of medical procedures was examined, making it difficult to generalize findings to other training methodologies and specialties. The absence of standardized assessment criteria further complicates direct intervention comparisons. These limitations are shortly discussed in [Fig. 2].

Fig. 2 The benefits, limitations, future aspects, and simulators in a summarized form.

Future Prospects and Directions

New technological innovations in surgical healthcare will enable better guidance during operations and preoperative surgical planning. Medical experts determined that AI will enable intraoperative VR overlays to enhance surgical visualization, thus achieving better accuracy while minimizing procedural risks.[3] The importance of using VR technology to educate patients before surgery increases as the technology continues to advance. A study has identified the current applications of VR, which help patients experience simulated surgery to reduce their preoperative nervousness. Internationally, authoritative sources project that future surgical planning interfaces could deliver VR frameworks enabling patients to visualize their customized surgical path with interactive interfaces tailored to their needs.[35] The performance of VR-assisted training surpasses traditional training methods by demonstrating superior educational results. The results of student learning improve when AI-based VR tutors adjust curricula according to individual performance levels. This strongly suggests that future surgical curricula will adopt standardized VR-based neurosurgical education to produce uniform student competence.[12] [25] From a clinical perspective, VR has experienced increasing adoption in neurosurgery primarily because of its usefulness in planning tumor resections. The findings of scientific studies demonstrate that stereoscopic VR models assist neurosurgeons in understanding tumors while developing complex surgical plans. The existing literature has established individualized intracranial aneurysm simulators for medical use with patients. Research points to the potential development of complete immersive AI-powered surgical rehearsal systems that would improve procedural precision.[17] [22] Also, researchers found positive results when studying brain–machine interfaces (BMIs) and VR integration for the treatment of paraplegia patients since it promoted neural plasticity and improved motor skills. Research must concentrate on developing intelligent noninvasive BMI systems that would boost neurorehabilitation treatments for various neurological conditions.[34] The VR technology shows promise to support both military instruction and remote surgical practices in conditions that lack sufficient resources. Research conducted on an evaluation of mixed-reality surgical mentoring as it applies to combat casualty care. Real-time remote surgical operations will become possible through VR-assisted telesurgery because this system enables experienced surgeons to perform robotically assisted medical procedures on separated patients.[36] Research shows that VR-based surgical rehearsal platforms for aneurysm clipping lead to better performance and improved surgeon confidence, according to studies. New advances in haptic feedback VR simulations are expected to deliver a better surgical experience to surgeons who can thus refine their abilities.[16] Medical education through VR will maintain its ongoing expansion. Research today demonstrates the value of teaching surgical cases and virtual operating room examinations for resident medical education before actual clinical procedures.[37] [Fig. 2] represents the summary of future development in VR.

Standardizing VR-based assessments can lead to reorganizing current approaches in neurosurgical training programs. The findings of scholarly research indicate VR has a vital future role to play in board certification tests because it will enable neurosurgical candidates to demonstrate their surgical readiness through simulated practice before operating on patients.[7] Besides, initial data indicate that VR can also facilitate postsurgical recovery through immersive and interactive treatment processes with the aim of promoting recovery and neuroplasticity enhancement.[38]

Conclusion

VR has emerged as a crucial tool, demonstrating its capabilities in various aspects of neurosurgery, ranging from preoperative planning of complex procedures to surgical training of students. Visualization of anatomical structures offered precision and accuracy, aiding neurosurgeons. It offers improved instrumental handling, tumor removal, and enhanced patient satisfaction. The combined impacts of AI and VR, along with 5G technology, make personalized surgical planning and remote surgeries possible and demand comprehensive research for refined clinical approaches, as it holds immense potential to revolutionize neurosurgery. For widespread application of VR into the neurosurgical field, the critical issues like accessibility, cost, and standard protocols need to be addressed. Thus, the integration of VR in neurosurgery is an expanding and evolving field that holds immense potential in the future world.

Conflict of Interest

None declared.

• References

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Artikel online veröffentlicht:
03. Dezember 2025