NeuroVR (previously NeuroTouch – caeneurovr.com) is the world’s most advanced virtual reality (VR) neurosurgical simulator, which has been developed by the National Research Council Canada with a consortium of university centres accross Canada. This multidisciplinary team includes strong clinical and research components from the Neurosurgical Simulation Research and Training Centre which was opened on September 10, 2010 at the Montreal Neurological Institute and Hospital (MNI/H). This centre, lead by Dr. Rolando Del Maestro and his team of dedicated researchers, is making significant progress in moving VR simulation into the world’s operating rooms.

The overall objective of the project is to improve patient safety through the development of VR-based rehearsal, training, planning and evaluation systems, integrated with MRI for patient-specific neurosurgical oncology and other advanced surgical procedures.

Neurosurgical oncology, the most frequently used cancer therapy, is evolving towards less invasive yet more complex procedures that require elaborate rehearsal to prevent operative errors (see video in Research Projects), improve patient safety, and enhance overall surgical outcome. Tumour resection is a high-risk procedure because of (i) potential damage to surrounding tissues, such as functional areas, nerves and blood vessels and (ii) increased risk of brain tumour recurrence from incomplete tumour removal. The expertise and technologies developed in this project are generic and will provide a solid foundation for rehearsing tumour resections, such as in abdominal, prostate and breast cancer. These VR systems can also be used to model complex cardiovascular, orthopedic and otolaryngology procedures.

The VR rehearsal system has unprecedented high-resolution haptics which provides a person with the ability to feel the difference between normal tissue and tumour tissue integrated with realistic tool-tissue behavior and high realism visualization. Enhanced MR images provide input information on critical anatomical structures, functional areas and tissue biomechanics.

For the first time these VR neurosurgical simulation systems are allowing the assessment of the tactile and visual cues that are important in determining how expert surgeons perform neurosurgical procedures. In partnership with many McGill neurosurgeons, clinical reality is being assured by developing procedural simulation capabilities for surgical procedures using tumour resection based on new experimental paradigms that can be assessed in virtual reality environments without risks to the patient. Surgeons and university hospitals from across Canada (including the Montreal Neurological Institute and Hospital), North America and internationally are playing an important role in the development, quantitative assessment and validation of this project.

The first bimanual neurosurgical simulator along with advanced neurosurgical oncology planning systems have been installed in the Neurosurgical Simulation Research and Training Centre at the Montreal Neurological Institute and Hospital. This simulator along with an advanced system to quantify the neurosurgical cognitive and technical expertise of residents and consultants (GAINS) is being developed in co-operation with Dr. Rolando Del Maestro and his team at the Montreal Neurological Institute and Hospital.

The MNI/H has been on the forefront in the past with the installation of the first CT scanner, the first MR scanner and the first PET scanner in Canada. This innovative Neurosurgical Simulator is the most advanced Simulator for surgical procedures that has been developed in the world and the MNI/MNH is the first neurosurgical center in the world to have a bimanual system that is developing both the technical and cognitive systems for metrics that could be used worldwide to assess essential neurosurgical operative skills. Industrial partners are cooperating with us to develop systems that will keep Canada the leader in simulation technologies.

Dr. Wong, Professor of Neurosurgery Chinese Univeristy of Hong Kong	Aysha Alsahawi, visiting medical student King Faisal University	Dr. Khalid Bajunaid, M.Sc. student McGill University