Virtual reality (VR) and augmented reality (AR) systems are increasingly available to neurosurgeons. These systems may provide opportunities for technical rehearsal and assessments of surgeon performance. The assessment of neurosurgeon skill in VR and AR environments and the validity of VR and AR feedback has not been systematically reviewed.

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted through MEDLINE and PubMed. Studies published in English between January 1990 and February 2021 describing the use of VR or AR to quantify surgical technical performance of neurosurgeons without the use of human raters were included. The types and categories of automated performance metrics (APMs) from each of these studies were recorded.

Thirty-three VR studies were included in the review; no AR studies met inclusion criteria. VR APMs were categorized as either distance to target, force, kinematics, time, blood loss, or volume of resection. Distance and time were the most well-studied APM domains, although all domains were effective at differentiating surgeon experience levels. Distance was successfully used to track improvements with practice. Examining volume of resection demonstrated that attending surgeons removed less simulated tumor but preserved more normal tissue than trainees. More recently, APMs have been used in machine learning algorithms to predict level of training with a high degree of accuracy. Key limitations to enhanced-reality systems include limited AR usage for automated surgical assessment and lack of external and longitudinal validation of VR systems.

VR has been used to assess surgeon performance across a wide spectrum of domains. The VR environment can be used to quantify surgeon performance, assess surgeon proficiency, and track training progression. AR systems have not yet been used to provide metrics for surgeon performance assessment despite potential for intraoperative integration. VR-based APMs may be especially useful for metrics that are difficult to assess intraoperatively, including blood loss and extent of resection.

神经外科医生越来越多地使用虚拟现实 (VR) 和增强现实 (AR) 系统。这些系统可为技术演练和外科医生表现评估提供机会。VR 和 AR 环境中神经外科医生技能的评估以及 VR 和 AR 反馈的有效性尚未得到系统审查。

通过 MEDLINE 和 PubMed 进行了遵循系统评价和元分析首选报告项目 (PRISMA) 指南的系统评价。1990 年 1 月至 2021 年 2 月期间以英文发表的研究描述了使用 VR 或 AR 来量化神经外科医生的手术技术性能，而无需使用人工评估员。记录了来自每项研究的自动性能指标 (APM) 的类型和类别。

33 项 VR 研究被纳入审查；没有 AR 研究符合纳入标准。VR APM 被分类为到目标的距离、力、运动学、时间、失血量或切除量。距离和时间是研究最多的 APM 领域，尽管所有领域在区分外科医生经验水平方面都是有效的。距离成功地用于跟踪实践的改进。检查切除量表明，与受训者相比，主治外科医生切除的模拟肿瘤较少，但保留了更多的正常组织。最近，APM 已被用于机器学习算法，以高度准确地预测训练水平。增强现实系统的主要限制包括有限的 AR 用于自动手术评估以及缺乏 VR 系统的外部和纵向验证。

VR 已被用于评估外科医生在广泛领域的表现。VR 环境可用于量化外科医生的表现、评估外科医生的熟练程度和跟踪培训进度。尽管有术中整合的潜力，但 AR 系统尚未用于为外科医生绩效评估提供指标。基于 VR 的 APM 可能对术中难以评估的指标特别有用，包​​括失血量和切除范围。