Neurosurgery Simulation Core

The Neurosurgery Simulation Core is one of the first academic neurosurgery simulation research centers in the world. Established in 2012 and co-directed by Clinical Director Joshua B. Bederson, MD, and Scientific Director Anthony B. Costa, PhD, the Neurosurgery Simulation Core at Mount Sinai includes students, residents, attending neurosurgeons, and researchers, all of whom are motivated by our ultimate goal: to improve outcomes and reduce complications in patients undergoing brain surgery by leveraging the potential of novel surgical training, pre- and intraoperative simulation, and visualization technologies.


The Neurosurgery Simulation Core is actively involved in a variety of research projects, both basic and applied, to advance the field of Neurosurgical Simulation. We engage in a collaborative approach with academia and our industry partners to develop real-world, clinically relevant solutions to these problems.

Perhaps the largest problem in brain surgery simulation is the differentiation of similar structures from imaging. In many ways this is comparable to the problem of neurosurgery itself where complex relationships between similar, but functionally distinct, brain structures must be understood in order to achieve the desired outcome for patients. Our group focuses on the development of extremely fast software tools for the segmentation of brain structures that are currently difficult to model, such as cranial nerves, so that they can be included in downstream simulations and 3D prints for our patients and for basic research purposes.

Recently, an explosion of technologies have been developed in both academia and industry which transform the way 3D data is used to guide planning and execution of surgical procedures. Examples of these technologies include haptic neurosurgery simulation, advanced 3D visualization tools such as virtual and augmented reality displays, developments in interactive neuronavigation, advanced microscope integration, robotic controls, and 3D printing—all economical and on timescales relevant for patient care. In each use case, a complex interplay between technologies from the radiologist to the surgeon is necessary to achieve a meaningful result. Our research and development in the practice of neurosurgery simulation is therefore focused on the integration of multiple information sources into a comprehensible, non-distracting workflow that maximally benefits patient safety and outcome.

In addition to their intraoperative use, computer-based virtual reality simulations of intracranial pathology are used in clinical practice with increasing frequency. We are extremely interested in understanding the benefits of so-called “simulation-based” consultation for enhanced understanding of patient-specific anatomy and pathology. Our preliminary data suggests increased patient confidence and a better appreciation of surgical alternatives in discussion with patients and their family members.


At various times throughout the year, discussions, symposiums, and consultations will be held globally to further our understanding of neurosurgery and the latest technological advances impacting these procedures. From witnessing 3D-printing demonstrations of a severe scoliotic spine for pre-surgical planning, to listening to a leading expert explain how CT ventriculography can assess and monitor the hydrocephalus during a subarachnoid hemorrhage, these events bridge the gap between the important work done in laboratories, and the vital decision-making being handled by doctors before and after brain operations.

But even though these conferences deal with complex surgical topics, the simulation environments reveal the transformative possibilities of the latest technology on neurosurgical procedures in truly fascinating ways. Hands-on demonstrations in workshops, coupled with lectures featuring sophisticated computer imagery, can reveal the future of surgical optimization right before our eyes. And by attending any of these events, researchers and clinicians can participate in a vital exchange of neuroscientific information that is sure to inform, educate, and enlighten everyone involved.


American Association of Neurological Surgeons, April 22-26, 2017, Los Angeles, CA
Workshop: Advanced Use of Computer-based Simulation Technologies for Intracranial Surgery

Date: Sunday, April 23rd 7:30 am - 4:30 pm
Clinical Fee: $500
Candidate and Medical Student Fee: Free
Directors: Joshua B. Bederson, MD, FAANS and Anthony B. Costa, PhD

In this satellite symposium, attendees will learn the theory and fundamentals of digital intraoperative tools and examples of successful clinical practices in which they have been implemented. The symposium will consist lectures on the current state of the art in, among other topics, intraoperative navigation, augmented reality, 3D visualization, and robotics, together with hands-on demonstrations and interactive sessions with software that implement these tools from academia and industry. Practical sessions will include demonstrations by cross-disciplinary neurosurgeons and related specialists, detailing how they are pushing the envelope of patient care by leveraging state-of-the-art digital tools.

Learning Objectives: After completing this educational activity, participants should be able to:

Recognize the disparate tools and technologies necessary for successful use of computer-based simulation strategies for intracranial surgery throughout the entire patient pipeline.

Define best practices in each category of the pipeline of tools used for computer based modeling and simulation in neurologic surgery, including strategies for optimization of radiological scan sequences, techniques for automated and semi-automated segmentation and registration of brain structures and available visualization techniques including virtual and augmented reality tools

Identify how simulation and modeling are pushing the envelope of patient care by leveraging state-of-the-art digital tools 

Radiological Society of North America Annual Meeting 2016, November 27-December 2, 2016, Chicago, IL
Talk: Complex Segmentation and On-site 3D Printing of Severe Scoliotic Spine for Pre-Surgical Planning and Intra-Operative Visualization.

SciViz.NYC, November 18, 2016, New York, NY
Talk: Toward immersive, interactive visualization in medicine: from the patient to the operating room.

Supercomputing 2016, November 13-18, 2016, Salt Lake City, UT
Workshop: Taking Supercomputing to the Clinic: Medical Image Analysis and Visualization.

Sarkiss V, Philemond V, Lee V, Sobotka V, Holloway TD, Moore M, Costa AB, Gordon E, Bederson JB. Neurosurgical skill assessment: measuring technical proficiency in neurosurgery residents through intraoperative video evaluations. World Neurosurgery; 89 2016. 1-8. doi: 10.1016/j.wneu.2015.12.052.

Sultana S, Blatt JE, Lee Y, Ewend M, Cetas JS, Costa AB, Audette M. Patient-specific cranial nerve identification using a discrete deformable contour model for skull base neurosurgery planning and simulation, lecture notes in computer science; 4901. 2016 36-44. doi: 10.1007/978-3-319-31808-0_5.

Holloway T, Lorsch ZS, M. A. Chary MA, Sobotka S, Moore MM, Costa AB, Del Maestro RF, Bederson J. Operator experience determines performance in a simulated computer-based brain tumor resection task. Int. J. CARS 10; 2015. 1853-1862. doi: 10.1007/s11548-015-1160-y.