{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T16:09:16Z","timestamp":1780934956294,"version":"3.54.1"},"reference-count":81,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2022,8,14]],"date-time":"2022-08-14T00:00:00Z","timestamp":1660435200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Innovationsfonden","award":["FoUI-941760"],"award-info":[{"award-number":["FoUI-941760"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Surgical simulation practices have witnessed a rapid expansion as an invaluable approach to resident training in recent years. One emerging way of implementing simulation is the adoption of extended reality (XR) technologies, which enable trainees to hone their skills by allowing interaction with virtual 3D objects placed in either real-world imagery or virtual environments. The goal of the present systematic review is to survey and broach the topic of XR in neurosurgery, with a focus on education. Five databases were investigated, leading to the inclusion of 31 studies after a thorough reviewing process. Focusing on user performance (UP) and user experience (UX), the body of evidence provided by these 31 studies showed that this technology has, in fact, the potential of enhancing neurosurgical education through the use of a wide array of both objective and subjective metrics. Recent research on the topic has so far produced solid results, particularly showing improvements in young residents, compared to other groups and over time. In conclusion, this review not only aids to a better understanding of the use of XR in neurosurgical education, but also highlights the areas where further research is entailed while also providing valuable insight into future applications.<\/jats:p>","DOI":"10.3390\/s22166067","type":"journal-article","created":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T23:44:03Z","timestamp":1660607043000},"page":"6067","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["Extended Reality in Neurosurgical Education: A Systematic Review"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5634-8960","authenticated-orcid":false,"given":"Alessandro","family":"Iop","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, 141 86 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden"},{"name":"KTH Royal Institute of Technology, 114 28 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9479-761X","authenticated-orcid":false,"given":"Victor Gabriel","family":"El-Hajj","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, 141 86 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3614-8782","authenticated-orcid":false,"given":"Maria","family":"Gharios","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, 141 86 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6064-5634","authenticated-orcid":false,"given":"Andrea","family":"de Giorgio","sequence":"additional","affiliation":[{"name":"SnT\u2014Interdisciplinary Center for Security, Reliability and Trust, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2993-511X","authenticated-orcid":false,"given":"Fabio Marco","family":"Monetti","sequence":"additional","affiliation":[{"name":"KTH Royal Institute of Technology, 114 28 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8781-1169","authenticated-orcid":false,"given":"Erik","family":"Edstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, 141 86 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3776-6136","authenticated-orcid":false,"given":"Adrian","family":"Elmi-Terander","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, 141 86 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4616-189X","authenticated-orcid":false,"given":"Mario","family":"Romero","sequence":"additional","affiliation":[{"name":"KTH Royal Institute of Technology, 114 28 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,14]]},"reference":[{"key":"ref_1","first-page":"2054270415616548","article-title":"Aviation and healthcare: A comparative review with implications for patient safety","volume":"7","author":"Kapur","year":"2015","journal-title":"JRSM Open"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s00381-015-2923-z","article-title":"The Role of Simulation in Neurosurgery","volume":"32","author":"Rehder","year":"2016","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.wneu.2018.07.015","article-title":"Effectiveness of cadaveric simulation in neurosurgical training: A review of the literature","volume":"118","author":"Gnanakumar","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_4","first-page":"S801","article-title":"3D printing in neurosurgery education: A review","volume":"7","author":"Bernstein","year":"2021","journal-title":"3D Print. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"E15","DOI":"10.3171\/2021.5.FOCUS21210","article-title":"A systematic review of virtual reality for the assessment of technical skills in neurosurgery","volume":"51","author":"Chan","year":"2021","journal-title":"Neurosurg. Focus"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1016\/j.wneu.2017.06.140","article-title":"Virtual reality and simulation in neurosurgical training","volume":"106","author":"Bernardo","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1016\/j.bjps.2020.05.081","article-title":"Virtual and augmented reality for preoperative planning in plastic surgical procedures: A systematic review","volume":"73","author":"Vles","year":"2020","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.wneu.2018.08.082","article-title":"Development of a virtual reality preoperative planning system for postlateral endoscopic lumbar discectomy surgery and its clinical application","volume":"123","author":"Zheng","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Lai, M., Skyrman, S., Shan, C., Babic, D., Homan, R., Edstr\u00f6m, E., Persson, O., Burstr\u00f6m, G., Elmi-Terander, A., and Hendriks, B.H. (2020). Fusion of augmented reality imaging with the endoscopic view for endonasal skull base surgery; a novel application for surgical navigation based on intraoperative cone beam computed tomography and optical tracking. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0229454"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Frisk, H., Lindqvist, E., Persson, O., Weinzierl, J., Bruetzel, L.K., Cewe, P., Burstr\u00f6m, G., Edstr\u00f6m, E., and Elmi-Terander, A. (2022). Feasibility and Accuracy of Thoracolumbar Pedicle Screw Placement Using an Augmented Reality Head Mounted Device. Sensors, 22.","DOI":"10.3390\/s22020522"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1038\/s41598-020-57693-5","article-title":"Augmented reality navigation with intraoperative 3D imaging vs fluoroscopy-assisted free-hand surgery for spine fixation surgery: A matched-control study comparing accuracy","volume":"10","author":"Fagerlund","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Voinescu, A., Sui, J., and Stanton Fraser, D. (2021). Virtual Reality in Neurorehabilitation: An Umbrella Review of Meta-Analyses. J. Clin. Med., 10.","DOI":"10.3390\/jcm10071478"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.genhosppsych.2021.04.008","article-title":"Use of virtual reality in the inpatient rehabilitation of COVID-19 patients","volume":"71","author":"Kolbe","year":"2021","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_14","unstructured":"Slond, F., Liesdek, O.C., Suyker, W.J., and Weldam, S.W. (2021). The use of virtual reality in patient education related to medical somatic treatment: A scoping review. Patient Educ. Couns."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"okaa004","DOI":"10.1093\/neuopn\/okaa004","article-title":"Impact of neurosurgical consultation with 360-degree virtual reality technology on patient engagement and satisfaction","volume":"1","author":"Louis","year":"2020","journal-title":"Neurosurg. Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s00701-020-04303-y","article-title":"Informed consent through 3D virtual reality: A randomized clinical trial","volume":"163","author":"Perin","year":"2021","journal-title":"Acta Neurochir."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.wneu.2017.06.142","article-title":"Microsurgical performance after sleep interruption: A NeuroTouch simulator study","volume":"106","author":"Micko","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1017\/S0022215116009233","article-title":"Effects of anatomical variation on trainee performance in a virtual reality temporal bone surgery simulator","volume":"131","author":"Piromchai","year":"2017","journal-title":"J. Laryngol. Otol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/SIH.0b013e3182662c69","article-title":"Practice on an augmented reality\/haptic simulator and library of virtual brains improves residents\u2019 ability to perform a ventriculostomy","volume":"8","author":"Yudkowsky","year":"2013","journal-title":"Simul. Healthc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1002\/jsid.636","article-title":"Live delivery of neurosurgical operating theater experience in virtual reality","volume":"26","author":"Salmimaa","year":"2018","journal-title":"J. Soc. Inf. Disp."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"25","DOI":"10.3389\/fsurg.2021.629963","article-title":"Virtual connections: Improving global neurosurgery through immersive technologies","volume":"8","author":"Higginbotham","year":"2021","journal-title":"Front. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.wneu.2015.08.053","article-title":"Virtual interactive presence in global surgical education: International collaboration through augmented reality","volume":"86","author":"Davis","year":"2016","journal-title":"World Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1186\/s12909-020-1994-z","article-title":"The effectiveness of virtual reality-based technology on anatomy teaching: A meta-analysis of randomized controlled studies","volume":"20","author":"Zhao","year":"2020","journal-title":"BMC Med. Educ."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1016\/j.anl.2021.03.009","article-title":"Patient-specific virtual and mixed reality for immersive, experiential anatomy education and for surgical planning in temporal bone surgery","volume":"48","author":"Yamazaki","year":"2021","journal-title":"Auris Nasus Larynx"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"727","DOI":"10.5312\/wjo.v12.i10.727","article-title":"Mixed reality for visualization of orthopedic surgical anatomy","volume":"12","author":"Chytas","year":"2021","journal-title":"World J. Orthop."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.jocn.2019.05.038","article-title":"Preliminary application of mxed reality in neurosurgery: Development and evaluation of a new intraoperative procedure","volume":"67","author":"Zhang","year":"2019","journal-title":"J. Clin. Neurosci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1093\/ons\/opx189","article-title":"Virtual reality tumor resection: The force pyramid approach","volume":"14","author":"Sawaya","year":"2018","journal-title":"Oper. Neurosurg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"192","DOI":"10.3171\/2018.2.JNS172327","article-title":"Development of a Performance Model for Virtual Reality Tumor Resections","volume":"13","author":"Sawaya","year":"2019","journal-title":"J. Neurosurg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/j.jsurg.2019.11.011","article-title":"Tremor assessment during virtual reality brain tumor resection","volume":"77","author":"Siyar","year":"2020","journal-title":"J. Surg. Educ."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1016\/j.jsurg.2015.04.030","article-title":"Evaluation of Sensory and Motor Skills in Neurosurgery Applicants Using a Virtual Reality Neurosurgical Simulator: The Sensory-Motor Quotient","volume":"72","author":"Roitberg","year":"2015","journal-title":"J. Surg. Educ."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1016\/j.jsurg.2016.04.013","article-title":"Bimanual psychomotor performance in neurosurgical resident applicants assessed using NeuroTouch, a virtual reality simulator","volume":"73","author":"Bajunaid","year":"2016","journal-title":"J. Surg. Educ."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1227\/NEU.0000000000000503","article-title":"Mixed reality ventriculostomy simulation: Experience in neurosurgical residency","volume":"10","author":"Hooten","year":"2014","journal-title":"Oper. Neurosurg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"103778","DOI":"10.1016\/j.compedu.2019.103778","article-title":"A systematic review of immersive virtual reality applications for higher education: Design elements, lessons learned, and research agenda","volume":"147","author":"Radianti","year":"2020","journal-title":"Comput. Educ."},{"key":"ref_34","unstructured":"Albert, B., and Tullis, T. (2013). Measuring the User Experience: Collecting, Analyzing, and Presenting Usability Metrics, Newnes."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.wneu.2021.08.150","article-title":"Virtual and Augmented Reality in Neurosurgery: The Evolution of its Application and Study Designs","volume":"161","author":"Jean","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.wneu.2012.11.066","article-title":"The role of simulation in neurosurgical education: A survey of 99 United States neurosurgery program directors","volume":"80","author":"Ganju","year":"2013","journal-title":"World Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"105906","DOI":"10.1016\/j.ijsu.2021.105906","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"88","author":"Page","year":"2021","journal-title":"Int. J. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan\u2014A web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1001\/jama.300.10.1181","article-title":"Internet-Based Learning in the Health Professions: A Meta-analysis","volume":"300","author":"Cook","year":"2008","journal-title":"JAMA"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"228","DOI":"10.3171\/2014.5.JNS131766","article-title":"The use of simulation in neurosurgical education and training: A systematic review","volume":"121","author":"Kirkman","year":"2014","journal-title":"J. Neurosurg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1007\/s00701-021-05003-x","article-title":"Evaluation of Simulation Models in Neurosurgical Training According to Face, Content, and Construct Validity: A Systematic Review","volume":"164","author":"Chawla","year":"2022","journal-title":"Acta Neurochir."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jocn.2021.09.037","article-title":"Examining the benefits of extended reality in neurosurgery: A systematic review","volume":"94","author":"Dadario","year":"2021","journal-title":"J. Clin. Neurosci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.wneu.2017.11.132","article-title":"Virtual Reality\u2013Based Simulators for Cranial Tumor Surgery: A Systematic Review","volume":"110","author":"Mazur","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"4174","DOI":"10.1007\/s00464-016-4800-6","article-title":"Systematic Review on the Effectiveness of Augmented Reality Applications in Medical Training","volume":"30","author":"Barsom","year":"2016","journal-title":"Surg. Endosc."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Innocente, C., Ulrich, L., Moos, S., and Vezzetti, E. (2022). Augmented Reality: Mapping Methods and Tools for Enhancing the Human Role in Healthcare HMI. Appl. Sci., 12.","DOI":"10.3390\/app12094295"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1227\/NEU.0000000000000583","article-title":"Virtual Reality Cerebral Aneurysm Clipping Simulation with Real-Time Haptic Feedback","volume":"11","author":"Alaraj","year":"2015","journal-title":"Oper. Neurosurg."},{"key":"ref_47","first-page":"89","article-title":"Assessing Bimanual Performance in Brain Tumor Resection with NeuroTouch, a Virtual Reality Simulator","volume":"11","author":"Alotaibi","year":"2015","journal-title":"Neurosurgery"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.jsurg.2014.12.014","article-title":"Proficiency Performance Benchmarks for Removal of Simulated Brain Tumors Using a Virtual Reality Simulator NeuroTouch","volume":"72","author":"AlZhrani","year":"2015","journal-title":"J. Surg. Educ."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e38","DOI":"10.1136\/jnnp-2019-ABN.121","article-title":"P56 Virtual reality simulation in neurosurgical training: A single blinded randomised controlled trial & review of all available training models","volume":"90","author":"Ansaripour","year":"2019","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s11548-014-1091-z","article-title":"Neurosurgical Virtual Reality Simulation Metrics to Assess Psychomotor Skills during Brain Tumor Resection","volume":"10","author":"Azarnoush","year":"2015","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Azimi, E., Molina, C., Chang, A., Huang, J., Huang, C.M., and Kazanzides, P. (2018). Interactive training and operation ecosystem for surgical tasks in mixed reality. OR 2.0 Context-Aware Operating Theaters, Computer Assisted Robotic Endoscopy, Clinical Image-Based Procedures, and Skin Image Analysis, Springer.","DOI":"10.1007\/978-3-030-01201-4_3"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1227\/NEU.0000000000001317","article-title":"Simulation-Based Education for Endoscopic Third Ventriculostomy: A Comparison between Virtual and Physical Training Models","volume":"13","author":"Breimer","year":"2017","journal-title":"Oper. Neurosurg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jsurg.2017.06.018","article-title":"Automaticity of Force Application during Simulated Brain Tumor Resection: Testing the Fitts and Posner Model","volume":"75","author":"Bugdadi","year":"2018","journal-title":"J. Surg. Educ."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.jsurg.2018.06.012","article-title":"Is Virtual Reality Surgical Performance Influenced by Force Feedback Device Utilized?","volume":"76","author":"Bugdadi","year":"2019","journal-title":"J. Surg. Educ."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1080\/24699322.2017.1358400","article-title":"A New Head-Mounted Display-Based Augmented Reality System in Neurosurgical Oncology: A Study on Phantom","volume":"22","author":"Cutolo","year":"2017","journal-title":"Comput. Assist. Surg."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1016\/j.wneu.2013.09.040","article-title":"A Novel Virtual Reality Simulation for Hemostasis in a Brain Surgical Cavity: Perceived Utility for Visuomotor Skills in Current and Aspiring Neurosurgery Residents","volume":"80","author":"Gasco","year":"2013","journal-title":"World Neurosurg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11548-013-0905-8","article-title":"Assessing Performance in Brain Tumor Resection Using a Novel Virtual Reality Simulator","volume":"9","author":"Choudhury","year":"2014","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.1007\/s11548-015-1160-y","article-title":"Operator Experience Determines Performance in a Simulated Computer-Based Brain Tumor Resection Task","volume":"10","author":"Holloway","year":"2015","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"ref_59","first-page":"1","article-title":"Assessment of Learning Curves on a Simulated Neurosurgical Task Using Metrics Selected by Artificial Intelligence","volume":"1","author":"Ledwos","year":"2022","journal-title":"J. Neurosurg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1007\/s10055-021-00578-3","article-title":"A Novel Virtual Reality Simulation Training System with Haptic Feedback for Improving Lateral Ventricle Puncture Skill","volume":"26","author":"Lin","year":"2021","journal-title":"Virtual Real."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1179\/1743132814Y.0000000405","article-title":"Neurosurgical Tactile Discrimination Training with Haptic-Based Virtual Reality Simulation","volume":"36","author":"Patel","year":"2014","journal-title":"Neurol. Res."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e130","DOI":"10.1016\/j.wneu.2021.06.145","article-title":"The \u201cSTARS-CASCADE\u201d Study: Virtual Reality Simulation as a New Training Approach in Vascular Neurosurgery","volume":"154","author":"Perin","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"E16","DOI":"10.3171\/2021.5.FOCUS21193","article-title":"Virtual Dissection of the Real Brain: Integration of Photographic 3D Models into Virtual Reality and Its Effect on Neurosurgical Resident Education","volume":"51","author":"Roh","year":"2021","journal-title":"Neurosurg. Focus"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.neuchi.2020.05.006","article-title":"Applying an Immersive Tutorial in Virtual Reality to Learning a New Technique","volume":"66","author":"Ros","year":"2020","journal-title":"Neuro-Chirurgie"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1227\/NEU.0000000000000074","article-title":"Virtual Reality-Based Simulation Training for Ventriculostomy: An Evidence-Based Approach","volume":"73","author":"Schirmer","year":"2013","journal-title":"Neurosurgery"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1227\/NEU.0000000000000853","article-title":"Usefulness of a Virtual Reality Percutaneous Trigeminal Rhizotomy Simulator in Neurosurgical Training","volume":"11","author":"Shakur","year":"2015","journal-title":"Oper. Neurosurg."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s42492-019-0015-8","article-title":"Assessing Performance of Augmented Reality-Based Neurosurgical Training","volume":"2","author":"Si","year":"2019","journal-title":"Vis. Comput. Ind. Biomed. Art"},{"key":"ref_68","first-page":"285","article-title":"A High-Fidelity Hybrid Virtual Reality Simulator of Aneurysm Clipping Repair with Brain Sylvian Fissure Exploration for Vascular Neurosurgery Training","volume":"16","year":"2021","journal-title":"Simul. Healthc. J. Soc. Simul. Healthc."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.jocn.2016.05.036","article-title":"Resident Simulation Training in Endoscopic Endonasal Surgery Utilizing Haptic Feedback Technology","volume":"34","author":"Thawani","year":"2016","journal-title":"J. Clin. Neurosci."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"e198363","DOI":"10.1001\/jamanetworkopen.2019.8363","article-title":"Machine Learning Identification of Surgical and Operative Factors Associated with Surgical Expertise in Virtual Reality Simulation","volume":"2","author":"Yilmaz","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e230","DOI":"10.1016\/j.wneu.2019.03.059","article-title":"A comparison of visual rating scales and simulated virtual reality metrics in neurosurgical training: A generalizability theory study","volume":"127","author":"Marwa","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_72","first-page":"4","article-title":"Sus: A \u201cquick and dirty\u2019usability","volume":"189","author":"Brooke","year":"1996","journal-title":"Usability Eval. Ind."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S0166-4115(08)62386-9","article-title":"Development of NASA-TLX (Task Load Index): Results of empirical and theoretical research","volume":"Volume 52","author":"Hart","year":"1988","journal-title":"Advances in Psychology"},{"key":"ref_74","unstructured":"Edmondson, D. (2005, January 1). Likert scales: A history. Proceedings of the Conference on Historical Analysis and Research in Marketing, Tampa, FL, USA."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"396","DOI":"10.9734\/BJAST\/2015\/14975","article-title":"Likert scale: Explored and explained","volume":"7","author":"Joshi","year":"2015","journal-title":"Br. J. Appl. Sci. Technol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e29080","DOI":"10.2196\/29080","article-title":"Augmented, mixed, and virtual reality-based head-mounted devices for medical education: Systematic review","volume":"9","author":"Barteit","year":"2021","journal-title":"JMIR Serious Games"},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Oke, A.E., and Arowoiya, V.A. (2021). Critical barriers to augmented reality technology adoption in developing countries: A case study of Nigeria. J. Eng. Des. Technol.","DOI":"10.1108\/JEDT-12-2020-0519"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1007\/BF03033421","article-title":"Immersive learning technologies: Realism and online authentic learning","volume":"19","author":"Herrington","year":"2007","journal-title":"J. Comput. High. Educ."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1177\/2327857919081006","article-title":"Mixed reality in medical education: A narrative literature review","volume":"Volume 8","author":"Barrie","year":"2019","journal-title":"Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11596-019-1992-8","article-title":"Application and prospect of mixed reality technology in medical field","volume":"39","author":"Hu","year":"2019","journal-title":"Curr. Med. Sci."},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Chen, S.C., and Duh, H. (2018, January 9\u201313). Mixed reality in education: Recent developments and future trends. Proceedings of the 2018 IEEE 18th International Conference on Advanced Learning Technologies (ICALT), Mumbai, India.","DOI":"10.1109\/ICALT.2018.00092"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/22\/16\/6067\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:08:28Z","timestamp":1760141308000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/22\/16\/6067"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,14]]},"references-count":81,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["s22166067"],"URL":"https:\/\/doi.org\/10.3390\/s22166067","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,14]]}}}