External ventricular drain (EVD) insertion using the freehand technique is often associated with misplacements resulting in unfavorable outcomes. Augmented Reality (AR) has been increasingly used to complement conventional neuronavigation. The accuracy of AR guided EVD insertion has been investigated in several studies, on anthropomorphic phantoms, cadavers, and patients. This review aimed to assess the current knowledge and discuss potential benefits and challenges associated with AR guidance in EVD insertion. MEDLINE, EMBASE, and Web of Science were searched from inception to August 2023 for studies evaluating the accuracy of AR guidance for EVD insertion. Studies were screened for eligibility and accuracy data was extracted. The risk of bias was assessed using the Cochrane Risk of Bias Tool and the quality of evidence was assessed using the Newcastle-Ottawa-Scale. Accuracy was reported either as the average deviation from target or according to the Kakarla grading system. Of the 497 studies retrieved, 14 were included for analysis. All included studies were prospectively designed. Insertions were performed on anthropomorphic phantoms, cadavers, or patients, using several different AR devices and interfaces. Deviation from target ranged between 0.7 and 11.9 mm. Accuracy according to the Kakarla grading scale ranged between 82 and 96%. Accuracy was higher for AR compared to the freehand technique in all studies that had control groups. Current evidence demonstrates that AR is more accurate than free-hand technique for EVD insertion. However, studies are few, the technology developing, and there is a need for further studies on patients in relevant clinical settings.

Extensive research has been conducted in multiple surgical specialities where Virtual Reality (VR) has been utilised, such as spinal neurosurgery. However, cranial neurosurgery remains relatively unexplored in this regard. This work explores the impact of adopting VR to study External Ventricular Drainage (EVD). In this study, pre-recorded Motion Captured data of an EVD procedure is visualised on a VR headset, in comparison to a desktop monitor condition. Participants (N = 20) ) were tasked with identifying and marking a key moment in the recordings. Objective and subjective metrics were recorded, such as completion time, temporal and spatial error distances, workload, and usability. The results from the experiment showed that the task was completed on average twice as fast in VR, when compared to desktop. However, desktop showed fewer error- prone results. Subjective feedback showed a slightly higher preference towards the VR environment concerning usability, while maintaining a comparable workload. Overall, VR displays are promising as an alternative tool to be used for educational and training purposes in cranial surgery.

Minimally invasive neurosurgery (MIS) involves inserting a medical instrument, e.g., a catheter, through a small incision to target an area inside the patient's body. Training surgeons to perform MIS is challenging since the surgical site is not directly visible from their perspective. In this paper, we conducted two pilot studies focused on object shapes and colors to collect preliminary results on their influence on depth perception for MIS in Virtual Reality. In the first study (N = 8), participants inserted a virtual catheter into objects of different shapes. In the second study (N = 5), they observed the insertion of a virtual catheter into objects of different colors and backgrounds under different lighting conditions. We found that participants' precision decreased with distance and was lower with the skull shape than with a cube. Moreover, depth perception was higher with blue backgrounds under better lighting conditions.

Purpose: This bibliometric analysis of the top 100 cited articles on extended reality (XR) in neurosurgery aimed to reveal trends in this research field. Gender differences in authorship and global distribution of the most-cited articles were also addressed. Methods: A Web of Science electronic database search was conducted. The top 100 most-cited articles related to the scope of this review were retrieved and analyzed for trends in publications, journal characteristics, authorship, global distribution, study design, and focus areas. After a brief description of the top 100 publications, a comparative analysis between spinal and cranial publications was performed. Results: From 2005, there was a significant increase in spinal neurosurgery publications with a focus on pedicle screw placement. Most articles were original research studies, with an emphasis on augmented reality (AR). In cranial neurosurgery, there was no notable increase in publications. There was an increase in studies assessing both AR and virtual reality (VR) research, with a notable emphasis on VR compared to AR. Education, surgical skills assessment, and surgical planning were more common themes in cranial studies compared to spinal studies. Female authorship was notably low in both groups, with no significant increase over time. The USA and Canada contributed most of the publications in the research field. Conclusions: Research regarding the use of XR in neurosurgery increased significantly from 2005. Cranial research focused on VR and resident education while spinal research focused on AR and neuronavigation. Female authorship was underrepresented. North America provides most of the high-impact research in this area.

Online learning has become an everyday form of learning for many students across different disciplines, including STEM subjects in the setting of higher education. Studying in these settings requires students to self-regulate their learning to a higher degree as compared to campus-based education. A vital aspect of self-regulated learning is the application of goal-setting strategies. Universities act to support students’ goal-setting through the achievement of course learning outcomes, which work both as a promise and metric of academic achievement. However, a lack of clear integration between course activities and course learning outcomes leaves a dissonance between students’ study efforts and the course progress. This demo study presents a student-centered learning analytics dashboard aimed at assisting students in their achievement of course learning goals in the setting of STEM higher education. The dashboard was designed using a design science methodological approach. Thirty-seven students have contributed to its development and evaluation during different stages of the design process, including the conceptual iterative design and prototyping. The preliminary results show that students found the tool to be easy to use and useful for the achievement of the course goals.

The adoption of Extended Reality (XR) technologies for supporting learning processes is an increasingly popular research topic for a wide variety of domains, including medical education. Currently, within this community, the metrics applied to quantify the potential impact these technologies have on procedural knowledge acquisition are inconsistent. This paper proposes a practical definition of standard metrics for the learning goals in the application of XR to surgical training. Their value in the context of previous research in neurosurgical training is also discussed. Objective metrics of performance include: spatial accuracy and precision, time-to-task completion, number of attempts. The objective definition of what the learner’s aims are enables the creation of comparable XR systems that track progress during training. The first impact is to provide a community-wide metric of progress that allows for consistent measurements. Furthermore, a measurable target opens the possibility for automated performance assessments with constructive feedback.

When modeling life-like Embodied Conversational Agents (ECAs), conveying politeness through verbal and nonverbal behaviors with persuasive intents is a significant challenge, as it underlies the conventional set of behavioral rules that govern human communication. In the present study, we explore the adherence to such rules in the context of joining a small, freestanding conversational group of agents in VR. In particular, we focus on the behavior adopted by participants while walking towards the agents, and on whether ECAs were treated in the same way human agents normally are. 45 test subjects were invited by an ECA to walk towards the group by applying one of six possible politeness strategies; after freely joining the group, they were asked to rate the agent's politeness according to four distinct aspects (Clarity, Face loss, Positive face, and Negative face). Across all strategies, in 48% of the trials participants were successfully persuaded to join the group at an inconvenient location. Out of those trials, participants adhered to social conventions by not crossing the convex empty space between the group members (o-space) in 75% of them on average. Additionally, analysis of verbal and nonverbal behaviors in ECAs shows that direct request strategies are more effective than indirect ones, although in some cases they may be perceived as less polite.

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.

Knocking sounds are highly expressive. In our previous research we have shown that from the sound of knocking actions alone a person can differentiate between different basic emotional states. In media productions, such as film and games, knocks can be very important storytelling de- vices as they allow the story to transition from one part to another. Research has shown that colours can affect our perception of emotions. However the relationship between colours and emotions is complex and dependent on mul- tiple factors. In this study we investigate how the visual characteristics of a door, more specifically its colour, tex- ture and material, presented together with emotionally ex- pressive knocking actions, can affect the perception of the overall emotion evoked in the audience. Results show that the doorÀs visual characteristics have little effect on the overall perception of emotions, which remains dominated by the emotions expressed by the knocking sounds.

Knocking sounds are highly meaningful everyday sounds. There exist many ways of knocking, expressing important information about the state of the person knocking and their relationship with the other side of the door. In media production, knocking sounds are important storytelling devices: they allow transitions to new scenes and create expectations in the audience. Despite this important role, knocking sounds have rarely been the focus of research. In this study, we create a data set of knocking actions performed with different emotional intentions. We then verify, through a listening test, whether these emotional intentions are perceived through listening to sound alone. Finally, we perform an acoustic analysis of the experimental data set to identify whether emotion-specific acoustic patterns emerge. The results show that emotional intentions are correctly perceived for some emotions. Additionally, the emerging emotion-specific acoustic patterns confirm, at least in part, findings from previous research in speech and music performance.