Augmented reality head-mounted display–based incision planning in cranial neurosurgery: a prospective pilot study

Abstract

OBJECTIVE Monitor and wand–based neuronavigation stations (MWBNSs) for frameless intraoperative neuronavigation are routinely used in cranial neurosurgery. However, they are temporally and spatially cumbersome; the OR must be arranged around the MWBNS, at least one hand must be used to manipulate the MWBNS wand (interrupting a bimanual surgical technique), and the surgical workflow is interrupted as the surgeon stops to “check the navigation” on a remote monitor. Thus, there is need for continuous, real-time, hands-free, neuronavigation solutions. Augmented reality (AR) is poised to streamline these issues. The authors present the first reported prospective pilot study investigating the feasibility of using the OpenSight application with an AR head-mounted display to map out the borders of tumors in patients undergoing elective craniotomy for tumor resection, and to compare the degree of correspondence with MWBNS tracing. METHODS Eleven consecutive patients undergoing elective craniotomy for brain tumor resection were prospectively identified and underwent circumferential tumor border tracing at the time of incision planning by a surgeon wearing HoloLens AR glasses running the commercially available OpenSight application registered to the patient and preoperative MRI. Then, the same patient underwent circumferential tumor border tracing using the StealthStation S8 MWBNS. Postoperatively, both tumor border tracings were compared by two blinded board-certified neurosurgeons and rated as having an excellent, adequate, or poor correspondence degree based on a subjective sense of the overlap. Objective overlap area measurements were also determined. RESULTS Eleven patients undergoing craniotomy were included in the study. Five patient procedures were rated as having an excellent correspondence degree, 5 had an adequate correspondence degree, and 1 had poor correspondence. Both raters agreed on the rating in all cases. AR tracing was possible in all cases. CONCLUSIONS In this small pilot study, the authors found that AR was implementable in the workflow of a neurosurgery OR, and was a feasible method of preoperative tumor border identification for incision planning. Future studies are needed to identify strategies to improve and optimize AR accuracy.

How is the Digital Surgical Environment Evolving? The Role of Augmented Reality in Surgery and Surgical Training

“…Organs and systems with low mobility and deformation require low tracking and tracing power from the AR devices, whereas highly mobile organs, such as bowel, require a more complicated track and display process. Taking these factors into consideration, the specialties that have shown great favour towards adopting AR technology include Neurosurgery [16,33,36,40], Ear, Nose and Throat (ENT) surgery [34], Maxillofacial surgery [7,41], and Orthopaedic surgery [25,28,29]. The use of AR in other operative modalities, including laparoscopic surgery and robotic surgery, has been expanding rapidly.…”

A Smarter Health through the Internet of Surgical Things

“…These data are then used to make reconstructed models of the anatomical area of interest. Such models are then transmitted wirelessly to a modality of choice, ranging from augmented reality (AR) glasses to the viewing screen of a surgical robot [54][55][56][57][58][59]. A simplified schematic illustrating the workflow of these systems can be seen in Figure 2, encompassing the idea of the IoT concept defined as a network of inter-connected devices that process and exchange data.…”

“…Studies on real-time surgery indicate that IGS has been very helpful in the identification and preservation of vital structures [58,59,61]. Almost all of the reports included here report that AR imaging systems allowed the preservation of vital structures in real-life patients [60][61][62][63][64], significant accuracy when utilized to assist in biopsies or electrode insertion [54][55][56][57][58][59] and real-time compensation for brain shift during neurological surgery [54], a novelty not achievable otherwise. In a study by Watanabe et al [60], the intra-operative tablet devices, used to provide live camera views of the surgical field were also tracked in space by an overhead multi-angle camera system and special tracking spheres [60][61][62][63][64].…”

“…On the other hand, the cost of implementation of such technological advances might prove to be restricting for certain institutions [54][55][56][57][58]. One of the biggest drawbacks of the systems described in the literature is that the vast majority of them report small patient cohorts and lack a direct comparison with other, more traditional surgical methods.…”

Mixed-Reality-Assisted Puncture of the Common Femoral Artery in a Phantom Model

“…Different methods of registration have been investigated, ranging from manual registration and automatic registration using optical tracking markers to registration assisted by commercially available navigation systems. The most investigated clinical application in the past has been pedicle screw placement during spine surgery, which has demonstrated promising initial results in several pilot studies [21][22][23][24][25][26]. In the field of vascular surgery, initial studies have also been conducted to investigate the potential of MR [16,27,28].…”