Over the last decade, the quality of neurosurgical procedures dramatically improved, also thanks to the development and increased accessibility of several technological recourses (e.g., imaging, neuronavigation, neurophysiology, microscopy), allowing to plan increasingly complex approaches, while reducing the risk of postoperative complications. Among these resources, three-dimensional rendering and simulation systems, such as virtual and augmented reality, provide a high-quality visual reconstruction of brain structures and interaction with advanced anatomical models. Although the usefulness of these systems is now widely recognized, the additional availability of proprioceptive (haptic) feedback might help to further enhance the realism of surgical simulation. A systematic literature review on the application of haptic technology in simulation of cranial neurosurgical procedures was made. Inclusion criteria were the usage of simulators with haptic feedback for specific neurosurgical procedures whereas the studies that did not include an evaluation of the surgical simulation system by a surgeon were excluded. According to inclusion and exclusion criteria, 10 studies were selected. Simulation in neurosurgery still lacks a system capable of rehearsing the entire procedure—from skin incision to skin closure—while providing both visual and proprioceptive feedback. Consequently, further advancements in this area are necessary.

Background: Cavernomas of the third ventricle are rare entities that provide significant therapeutic challenges. Because of the better view of the surgical field and the possibility to achieve a gross total resection (GTR), microsurgical approaches are more commonly used to target the third ventricle. Endoscopic transventricular approaches (ETVA), on the other hand, are minimally invasive procedures that can afford a straight corridor trough the lesion, avoiding bigger craniotomies. Moreover, these approaches have shown lower infectious risks and shorter hospitalization times. Case Description: A 58-year-old female patient accessed the Emergency Department complaining of headache, vomiting, mental confusion, and syncopal episodes for the past 3 days. An urgent brain computed tomography scan revealed a hemorrhagic lesion of the third ventricle, conditioning triventricular hydrocephalus, so an external ventricular drainage (EVD) was placed in an emergency setting. An magnetic resonance imaging (MRI) showed a 10 mm diameter hemorrhagic cavernous malformation originating from the superior tectal plate. An ETVA was performed for the cavernoma resection, followed by an endoscopic third ventriculostomy. After proving shunt independence, the EVD was removed. No clinical nor radiological complications were assisted in the postoperative period, so the patient was discharged 7 days after. The histopathological examination was consistent with cavernous malformation. An immediate postoperative MRI showed GTR of the cavernoma with a little clot around the surgical cavity, which appeared completely reabsorbed 4 months later. Conclusion: ETVA provides a straight corridor to the third ventricle, excellent visualization of the relevant anatomical structures, safe resection of the lesion, and treatment of the concomitant hydrocephalus by ETV.