4D Neurosurgery-Learning Brain Surgery from an Avatar.

Hydrocephalus is one of the most common pediatric neurosurgical conditions worldwide, with an incidence of approximately 6000 new cases in infants annually, 50% of which are congenital. While shunt placement remains a standard treatment, endoscopic third ventriculostomy (ETV) combined with choroid plexus cauterization (CPC) has emerged as a less invasive and durable alternative in selected cases. However, ETV-CPC is technically demanding and requires extensive surgical training, especially for pediatric populations. This chapter explores an innovative, mixed-reality simulation model that combines a physical baby simulator with an expert AI-driven avatar to reduce the learning curve for pediatric neuroendoscopy. The training model, designed specifically for use in under-resourced regions such as the Brazilian Amazon region, was evaluated and showed a 41.65% average decrease in surgical errors post-training. This chapter also discusses the global implications of this methodology for neurosurgical training and equitable medical education.