Background: The complexity of neurosurgical interventions demands innovative training solutions and standardized evaluation methods that in recent times have been the object of increased research interest. The objective is to establish an education curriculum on a phantom‑based training system incorporating theoretical and practical components for important aspects of brain tumor surgery. Methods: Training covers surgical planning of the optimal access path based on real patient data, setup of the navigation system including phantom registration and navigated craniotomy with real instruments. Nine residents from different education levels carried out three simulations on different data sets with varying tumor locations. Trainings were evaluated by a specialist using a uniform score system assessing tumor identification, registration accuracy, injured structures, planning and execution accuracy, tumor accessibility and required time. Results: Average scores improved from 16.9 to 20.4 between first and third training. Average time to craniotomy improved from 28.97 to 21.07 min, average time to suture improved from 37.83 to 27.47 min. Significant correlations were found between time to craniotomy and number of training (P < 0.05), between time to suture and number of training (P < 0.05) as well as between score and number of training (P < 0.01). Conclusion: The training system is evaluated to be a suitable training tool for residents to become familiar with the complex procedures of autonomous neurosurgical planning and conducting of craniotomies in tumor surgeries. Becoming more confident is supposed to result in less error‑prone and faster operation procedures and thus is a benefit for both physicians and patients.

Background: The complexity of neurosurgical interventions demands innovative training solutions and standardized evaluation methods that in recent times have been the object of increased research interest. The objective is to establish an education curriculum on a phantom‑based training system incorporating theoretical and practical components for important aspects of brain tumor surgery. Methods: Training covers surgical planning of the optimal access path based on real patient data, setup of the navigation system including phantom registration and navigated craniotomy with real instruments. Nine residents from different education levels carried out three simulations on different data sets with varying tumor locations. Trainings were evaluated by a specialist using a uniform score system assessing tumor identification, registration accuracy, injured structures, planning and execution accuracy, tumor accessibility and required time. Results: Average scores improved from 16.9 to 20.4 between first and third training. Average time to craniotomy improved from 28.97 to 21.07 min, average time to suture improved from 37.83 to 27.47 min. Significant correlations were found between time to craniotomy and number of training (P < 0.05), between time to suture and number of training (P < 0.05) as well as between score and number of training (P < 0.01). Conclusion: The training system is evaluated to be a suitable training tool for residents to become familiar with the complex procedures of autonomous neurosurgical planning and conducting of craniotomies in tumor surgeries. Becoming more confident is supposed to result in less error‑prone and faster operation procedures and thus is a benefit for both physicians and patients.

With its increasing potential, Virtual Reality (VR) technology has found a growing presence in medical education. In the domain of neurosurgical training, VR has been thoroughly investigated, but gaps still persist, such as in the field of Minimally Invasive Surgery (MIS) and assistive visualizations. Thus, this thesis project aims at combining visualizations of motion captured surgical simulation data with a VR environment for training in the minimally invasive procedure of External Ventricular Drain (EVD) placement. A user study was conducted with the goal of investigating effectiveness (in terms of speed, confidence, and accuracy) when identifying certain features of the trajectory of a catheter simulating an EVD placement. The conditions compared were two visualization techniques, 4D-time density and trail, as well as a VR and desktop environment. The study employed a betweensubjects design when comparing visualizations and a within-subjects design when comparing environments. Results from 20 participants indicate a higher speed for the 4D-time density visualization compared to the trail visualization and no visualization in the VR environment. Participants also found the 4D-time density visualization significantly more helpful in VR compared to desktop, when identifying one of the features. The VR environment also had a significant positive impact on speed as well as confidence for certain combinations of the conditions, compared to the desktop environment. Further, participants tended to prefer the VR environment and found tasks easier in this environment. In conclusion, the 4D-time density visualization and VR environment have the potential to improve efficiency when interpreting and understanding the trajectory of a catheter during EVD placement. / Med ökande potential har Virtuell Verklighet-teknik (VR) funnit en växande närvaro inom medicinsk utbildning. Specifikt inom neurokirurgisk utbildning har VR undersökts grundligt, men hål i forskningen kvarstår, exempelvis inom området för minimalinvasiv kirurgi (MIS) och assisterande visualiseringar. Detta examensarbete syftar därför att kombinera visualiseringar av kirurgisk simuleringsdata, inspelad med hjälp av motion capture-teknik, med en VRmiljö för träning i den minimalinvasiva proceduren placering av Externt Ventrikulär Dränage (EVD). En användarstudie genomfördes med målet att undersöka effektivitet (i termer av hastighet, självförtroende och exakthet) vid identifiering av vissa kännetecken hos en kateters bana som simulerar en EVDplacering. Villkoren som jämfördes var två visualiseringstekniker, 4D-time Density och trail, samt de två miljöerna VR och desktop. I studien användes en testdesign där visualiseringarna jämfördes mellan två testgrupper och miljöerna jämfördes inom testgruppen. Resultat från 20 deltagare indikerar en högre hastighet för 4D-time-density visualiseringen jämfört med trail visualiseringen och ingen visualisering i VR-miljön. Deltagarna uppfattade också 4D-time-density visualiseringen som betydligt mer hjälpsam i VR jämfört med desktop, när de identifierade en av kännetecknen. Ytterligare hade VR-miljön en signifikant positiv inverkan på deltagarnas hastighet samt självförtroende för vissa kombinationer av villkor, jämfört med desktopmiljön. Deltagarna tenderade också att föredra VR-miljön och uppfattade uppgifterna som lättare i denna miljö. Sammanfattningsvis har 4D-time density visualiseringen och VR-miljön potential att förbättra effektiviteten när man tolkar och bildar en uppfattning om en kateters bana under EVDplacering.