BACKGROUND: Neurosurgical 3D visualizers and simulators are innovative devices capable of defining a surgical strategy in advance and possibly making neurosurgery safer by rehearsing the phases of the operation beforehand. The aim of this study is to evaluate Surgical Theater™ (Surgical Theater LLC, Mayfield, OH, USA), a new 3D neurosurgical planning, simulation, and navigation system, and qualitatively assess its use in the operating room. METHODS: Clinical data were collected from 30 patients harboring various types of brain tumors; Surgical Theater™ was used for the preoperative planning and intraoperative 3D navigation. Preoperative and postoperative questionnaires were completed by first and second operators to get qualitative feedback on the system's functionality. Furthermore, we measured and compared the impact of this technology on surgery duration. RESULTS: Neurosurgeons were overall satisfied when using this rehearsal and navigation tool and found it efficient and easy to use; interestingly, residents considered this device more useful as compared to their more senior colleagues (with significantly higher scores, P<0.05), possibly because of their limited anatomical experience and spatial/surgical rehearsal ability. The length of the surgical procedure was not affected by this technology (P>0.05). CONCLUSIONS: Surgical Theater™ system was found to be clinically useful in improving anatomical understanding, surgical planning, and intraoperative navigation, especially for younger and less experienced neurosurgeons.

Besta NeuroSim Center 1 R C C S Neurological Institute and quot;Carlo Besta and quot; Foundation Milan Italy

Department of Life Sciences University of Trieste Trieste Italy

Department of Neurosurgery 1 R C C S Neurological Institute and quot;Carlo Besta and quot; Foundation Milan Italy

Department of Neurosurgery SS Antonio e Biagio e C Arrigo Hospital Alessandria Italy

Department of Neurosurgery University Hospitals of Geneva Geneva Switzerland

Department of Neurosurgery University of Naples Federico 2 Naples Italy

Department of Pathophysiology and Transplantation University of Milan Milan Italy

EANS Training Committee Prague Czech Republic

Johns Hopkins Medical School Department of Neurological Surgery Baltimore MD USA

Surgical Theater LLC Mayfield OH USA

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