Virtual Reality in Neurosurgery- A Neurostimulator – Based Postgraduate Residency Training: A Novel Step Towards Skillful Young Neurosurgeons

Introduction/Objective:  Virtual Reality (VR) is the need of time in every field of life. Recent biotechnological advances have molded the surgeon-computer relationship. Department of Neurosurgery Jinnah Hospital Lahore has updated the postgraduate training program by adding the virtual reality simulator. We aim to explore the current and future roles and applications of VR and simulation in neurosurgical training that may reduce the learning curve, improve conceptual understanding and enhance visuospatial skills. Materials & Methods:  Eight residents were enrolled in this program. They exercised the basic skills of neurosurgery e.g. suction, use of bipolar cautery, handling of CUSA, use of micro scissors, etc., and the automated software recorded each participant’s graph of performance separately. After 1.5 years, they were assessed in real-time on actual patients under the direct supervision of a qualified neurosurgeon. The assessment was done on DOPS (Directly Observed Procedural Skills) Performa. Results:  The results showed that there was a gradual upward learning curve in simulator-based procedures from negative marking to 70% in basic surgical skills and 60% in advanced procedures on average for all the residents whereas the DOPS showed that all residents performed above expectation i.e., 4 or above. Conclusion:  Neurostimulator-based postgraduate training program is opening new horizons for the safe and skillful training of residents. With the advancement of artificial intelligence, its use in training programs will lead to structured and systematic training patterns in the world of neurosurgery

Delay in Diagnosis of Brain Tumors: A Dilemma For Neurosurgical Community Due To Spirituality and Quackery In A Developing Country

Objectives:  Primary and metastatic brain tumors are a significant cause of mortality and morbidity. The complex pathway to a cancer diagnosis is not human error and the achievements of better outcomes solely depend on the early diagnosis and management of symptomatic tumors. The estimated time between the first presentation to any health care professional and diagnosis is approximately 3 times longer in the UK as compared to other developed countries. Material and Methods:  It was a descriptive study and included 52 patients who were admitted to the Neurosurgery department at Jinnah hospital Lahore. The required data were collected either directly from the patients or from the hospital record of discharged patients. Our study compares the time interval difference of presentation of a patient to a local care provider (Quacks, Hakeem, and spiritual healers) and Neurosurgeon as well as delay in surgical intervention even after diagnosis and radiological investigations. Results:  54% of patients presented with supratentorial lesions and out of these, parietal lobe lesions were more common (39%) while 29% of lesions were infratentorial. Around 50% of patients presented to a Local Care Provider within 20 days. However, only 42% of patients presented to a neurosurgeon after 6-9 months of the onset of symptoms. Conclusion:  Public awareness is the key to timely diagnosis, proper management, and better outcomes. The availability of specialists in peripheral hospitals can bring a change in this regard