Objectives Virtual reality (VR) simulators are one of the training models allowing the practice of surgical skills for trainees. We aim to assess the benefit of VR training in neurosurgery.

Design A single-blinded randomised controlled trial and a literature review.

Subjects Trainees (n=12), Fellows and Consultant Neurosurgeons (n=4) and Medical Students (n=6) with no experience of VR.

Methods Participants were randomised according to their grades. Both groups completed microsurgical tasks and duration and quality of each task was recorded at the start and the endpoint of the study. Questionnaires were used to assess the participants’ confidence in microsurgical skills. The intervention group underwent structured training using a VR simulator (NeuroVR). The primary outcome measure was microsurgical performance assessed by three independent assessors blinded to trainee status. The secondary outcome measure was performance time and confidence levels.

Results Observed improvements in the primary outcome were not significant. The performance time in the intervention group improved significantly with a mean difference of 79.8 s (8–178 s) (p<0.05). The intervention group reported significantly improved confidence levels in all microsurgical skills (8.8%, p<0.001). Less experienced trainees had the greatest reductions in time and improved confidence levels.

Conclusions VR training in neurosurgery, particularly in less experienced trainees, can prove useful. Future studies should assess the effect of VR training on clinical procedures.