Table 1.

This table pictures an extract of current available neurosurgical training simulators that use different approaches for material composition and technology

Simulator	Operating principle	Surgical scenarios	Strengths	Limitations
NeuroTouch [10]	VR	Resection of a meningioma-like lesion	Able to differentiate participants by their training level, performance metrics were recorded automatically	Visual and sensory realism only “acceptable”
Plug-and-play lifelike ETV training model [20]	3D prints and casting/molding	Endoscopic third ventriculostomy (ETV) in pediatric hydrocephalus	Realistic human-like external features; pulsation of ventricular cavities, basilar artery, and flow of CSF; plug-and-play component allows for reuse	Expenditure of money and time, merely one pathological condition, extremely realistic external facial features were not superior to low-fidelity training model
MARTYN [8]	polyurethane resin (skull), gelatin composite base (brain), paraffin (CSF), latex (dura mater), silicone (temporalis muscle)	Frontal/temporal craniotomies; insertion of external ventricular drains (EVD) via burr holes; evacuation of extradural hematomas	Inexpensive, accessible, various pathologies possible, no tissue act restrictions	Inevitable minor variabilities, expenditure of time
Mixed reality simulation [5]	3D prints in combination with a virtual radiographic system or image guidance platform	Ventriculostomy; percutaneous stereotactic lesion procedure for trigeminal neuralgia; spinal instrumentation	Appropriate real-world visual and haptic feedback, scanning is possible	Does not include fluids or nerves
Agar agar tumor model [12]	Injecting a mixture of fluorescein and agar agar in a sheep’s brain	Corticotomy and successive complete dissection of a defined gyrus using a dissector, suction and ultrasound aspirator, neurosurgical tumor resection	Cheap, easily accessible, simple, realistic haptic feedback, fluorescent in 5-ALA	No training of craniotomies, neurosurgical approaches or identification of bony landmarks, no use in the OR due to sanitary regulations
Neurosurgical training simulator for cerebrovascular bypass surgery [6]	Commercial composite physical model	Vascular anastomosis techniques, tumor models also possible when applying minor modifications	Cheap, reusable, free of infection risks, extra- and intracranial circulations, haptic properties superior to other microanastomosis simulators, and radiological imaging is possible	Visual and haptic feedback inferior to animal and cadaver heads, synthetic vessels with lack of adherence to surrounding tissue
“Live cadavers “[1]	cadavers that are connected to a pump with artificial blood flow	Management of intraoperative aneurysmal rupture, clipping aneurysms, training of all procedures possible including intracranial pressure reduction, traumatic injuries, bypass, artificial brain tumors, etc.	Realistic visual and haptic feedback and blood flow, bleeding, and tissue pulsation	Time consuming preparation of the cadaver, limited availability, sanitary regulations, short shelf life with a maximum of one week, high expenses

VR, virtual reality; ETV, endoscopic third ventriculostomy; CSF, cerebrospinal fluid; 5-ALA, gamma-aminolevulinic acid