VIRTUAL REALITY-ENHANCED FOR PREOPERATIVE ANATOMICAL ASSESSMENT OF ABDOMINAL NEUROBLASTOMA: A COMPARATIVE STUDY WITH CONVENTIONAL CT IMAGING.
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AIM: Accurate assessment of tumour anatomy is critical for neuroblastoma surgical planning. This study evaluated whether patient-specific virtual reality (VR) models improve the accuracy of pre-operative anatomical assessment compared with conventional computed tomography (CT) imaging. METHODS: CT scans from nine patients with abdominal neuroblastoma were segmented to create patient-specific VR models, which were then imported into an in-house VR application. Eleven paediatric surgeons (n=5 consultants; n=6 registrars) independently evaluated conventional CT images and VR reconstructions to assess vascular and organ involvement, image-defined risk factors (IDRFs), and operative strategies. Anatomical accuracy was quantified against intraoperative findings recorded in the International Neuroblastoma Surgical Report Form. Subjective ratings were collected using Likert scales. Mixed-effects models and non-parametric statistical analyses were conducted (p<0.05). RESULTS: VR significantly improved overall anatomical accuracy, with a mean increase of 12.4 percentage points (95% CI 8.5-16.3; p<0.0001). Improvements were observed for vascular involvement (+12.5%, p<0.001), organ involvement (+9.6%, p<0.01), and IDRF identification (+13.7%, p<0.0001). Improvements in anatomical accuracy with VR were similar between consultants and registrars. VR did not significantly alter operative planning decisions or predicted tumour resectability. Surgeons reported greater confidence in anatomical understanding and surgical planning with VR than CT (p<0.001). The VR platform received high ratings for usability, integration into the preoperative planning workflow, and perceived clinical value. CONCLUSION: VR improved surgeons' anatomical assessment accuracy and confidence compared with traditional CT scans, highlighting VR's potential as a useful supplement to conventional imaging for preoperative evaluation in complex abdominal neuroblastoma.