1 Gina Cody School of Engineering and Computer Science, Concordia University, 1515 Ste. Catherine St. W., Montreal, QC, H3G 2W1, Canada. p_oco@live.concordia.ca.
2 Department Electrical and Computer Engineering, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
3 Department of Clinical Neurological Sciences, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
4 Gina Cody School of Engineering and Computer Science, Concordia University, 1515 Ste. Catherine St. W., Montreal, QC, H3G 2W1, Canada.

Purpose: External ventricular drain (EVD) placement is a fundamental neurosurgical procedure for monitoring and relieving elevated intracranial pressure, yet catheter misplacement remains common, particularly during early training. Virtual reality (VR) simulation offers a scalable approach for procedural education. We present VIVIE, a standalone VR-based training system designed to support safe, repeatable practice of EVD placement.

Methods: VIVIE simulates key steps of EVD placement, including anatomical landmark identification, entry point selection, burr hole creation, and catheter insertion. A pilot user study was conducted with 15 novice participants who completed a structured tutorial followed by progressively more challenging training levels. Objective performance metrics were recorded alongside subjective measures of workload and usability. Two expert neurosurgeons evaluated the system through hands-on use and provided qualitative feedback on realism, workflow fidelity, and educational relevance.

Results: Novice participants demonstrated improved targeting accuracy and lateral control across training levels despite increasing task difficulty, indicating a measurable learning effect. Subjective evaluations indicated low to moderate workload, good perceived usability, and high user engagement. Expert reviewers highlighted the system's realism and educational potential, while identifying limitations related to interaction fidelity, depth perception, and anatomical detail.

Conclusion: VIVIE demonstrates feasibility as a VR-based training system for EVD, particularly for early-stage learners. These findings support its potential role in simulation-based neurosurgical education, while expert feedback underscores the importance of high-fidelity interaction and anatomical representation for advanced training. Future work will focus on system refinement and larger-scale validation to assess learning transfer and clinical relevance.