Neurosurgical simulation by interactive computer graphics on iPad

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Presurgical simulation before complicated neurosurgery is a state-of-the-art technique, and its usefulness has recently become well known. However, simulation requires complex image processing, which hinders its widespread application. We explored handling the results of interactive computer graphics on the iPad tablet, which can easily be controlled anywhere.


Data from preneurosurgical simulations from 12 patients (4 men, 8 women) who underwent complex brain surgery were loaded onto an iPad. First, DICOM data were loaded using Amira visualization software to create interactive computer graphics, and ParaView, another free visualization software package, was used to convert the results of the simulation to be loaded using the free iPad software KiwiViewer.


The interactive computer graphics created prior to neurosurgery were successfully displayed and smoothly controlled on the iPad in all patients. The number of elements ranged from 3 to 13 (mean 7). The mean original data size was 233 MB, which was reduced to 10.4 MB (4.4 % of original size) after image processing by ParaView. This was increased to 46.6 MB (19.9 %) after decompression in KiwiViewer. Controlling the magnification, transfer, rotation, and selection of translucence in 10 levels of each element were smoothly and easily performed using one or two fingers. The requisite skill to smoothly control the iPad software was acquired within 1.8 trials on average in 12 medical students and 6 neurosurgical residents.


Using an iPad to handle the result of preneurosurgical simulation was extremely useful because it could easily be handled anywhere.

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This work was supported in part by Takeda Science Foundation and grants-in-aid for scientific research awarded to Dr. Maruyama from the Ministry of Education, Science, and Culture of Japan (Grant No. 24592145).

Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to Keisuke Maruyama.

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Maruyama, K., Kin, T., Saito, T. et al. Neurosurgical simulation by interactive computer graphics on iPad. Int J CARS 9, 1073–1078 (2014) doi:10.1007/s11548-014-0993-0

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  • Interactive computer graphics
  • iPad
  • Neurosurgery
  • Simulation