Surgical Theater [Neurosurgery Wiki]

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====== Surgical Theater ======

https://surgicaltheater.com/

In a retrospective [[institution]]al [[experience]] with illustrative [[case]]s  
Shields LB et al.  
from the Norton Neuroscience Institute, [[Louisville]]  
published in [[Epilepsia Open]]  
to evaluate the role of the [[Surgical Theater]] (ST) [[3D]] [[visualization]] system in enhancing [[presurgical planning]] for [[pediatric epilepsy surgery]].  
The ST system enabled integration of multimodal imaging into immersive [[3D model]]s, improving collaborative [[surgical planning]], enhancing intraoperative [[navigation]], and allowing [[VR]]-based procedural rehearsal. It demonstrated utility across 85 cases and is posited as a promising adjunct for pediatric epilepsy surgical workflows
((Shields LBE, Abri H, Karakas C, Davis SD, Mutchnick IS. Novel [[planning]] [[pipeline]] utilizing the [[Surgical Theater]] [[system]] for [[pediatric epilepsy surgery]]. Epilepsia Open. 2025 Jul 9. doi: 10.1002/epi4.70094. Epub ahead of print. PMID: 40632587.))

==== Critical Review ====

This is a descriptive, non-comparative experience report centered on implementing the Surgical Theater (ST) system in a [[pediatric epilepsy]] context. While the authors present a visually compelling and potentially transformative [[workflow]] for [[presurgical planning]], the [[study]] is methodologically [[weak]]—it lacks controls, quantifiable [[outcome]]s, or statistical [[rigor]]. The "[[result]]s" are largely anecdotal, with 4 case examples insufficiently discussed in terms of surgical [[impact]] or [[clinical outcome]]s.

The ST system’s theoretical [[benefit]]s—improved anatomical understanding, [[interdisciplinar]]y [[collaboration]], and [[anxiety]] reduction—are intuitively appealing but require formal [[validation]]. There's no [[comparison]] to conventional [[planning]] or alternate [[navigation system]]s. The [[sample size]] (n=85) is respectable, but without [[outcome]] measures or procedural [[benchmark]]s (e.g., [[seizure]] freedom rates, operative times, [[complication]] rates), the [[article]] remains a [[promotion]]al showcase rather than [[evidence-based]] advancement.

==== Final Verdict ====

**Score:** 4/10  

**Takeaway for the Practicing Neurosurgeon:** [[Surgical Theater]] provides promising visual tools for complex planning, but current evidence is insufficient to justify its routine use in pediatric epilepsy surgery without further validation. 
 
**Bottom Line:** Potentially useful, but currently more [[marketing]] than medicine.