Augmented reality in intradural spinal tumor surgery

Carl, Barbara; Bopp, Miriam; Saß, Benjamin; Pojskić, Mirza; Nimsky, Christopher

doi:10.1007/s00701-019-04005-0

Cited by 64 publications

(49 citation statements)

References 36 publications

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“…The AR technology has recently been used to visualize organs and tumors during surgery. 13 – 16 Evaluations of the perforating artery of free flaps have also been performed on body surfaces. 17 – 19 Our method is projecting 3D images obtained by CTA.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative 3-dimensional Projection of Blood Vessels on Body Surface Using an Augmented Reality System

Katayama

Mitsuno

Kino

2020

Plastic and Reconstructive Surgery - Global Open

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Summary: Preoperative understanding of the running pattern of blood vessels is an important factor to approach surgical fields safely. In 2 cases where the vascular abnormalities were estimated, we projected the blood vessels onto the surgical field using an augmented reality device HoloLens. A splint was made to allow the patient to be fixed while undergoing computed tomographic angiography. Three-dimensional (3D) data on the blood vessels, skin surfaces, bones, and the 3 chosen points for alignment were segmented and then projected onto the body surfaces as holograms using the HoloLens. Two types of projection for holograms were used: projection type 1—where the body contours were projected as a line, and projection type 2—where the body surface was projected as meshed skin type. By projecting projection type 2 rather than projection type 1, we gained a better understanding of the 3D anatomic findings and deformation characteristics, including the anatomic blood vessel variation and positional relationships between the organs and body surfaces. To some extent, we could make sure that the depth perception can be obtained by recognizing the bone, vessels, or tumor inside the meshed skin surface. Our new method allows the 3D visualization of blood vessels from the body surface, and helps understand the 3D anatomic variation of the blood vessels to be applied as long as the blood vessels can be visualized.

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Section: Discussionmentioning

confidence: 99%

“…Sielhorst et al 7 suggested that one of the best visualization modes for interacting with a 3D model in medical AR is to use a virtual window. A virtual window 14 – 16 that could be overlaid onto the skin of the patient and partially occlude the organs would enhance the perceptive information regarding depth.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative 3-dimensional Projection of Blood Vessels on Body Surface Using an Augmented Reality System

Katayama

Mitsuno

Kino

2020

Plastic and Reconstructive Surgery - Global Open

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“…Details describing the setup were previously published, and no major modifications were necessary to apply the technique. [ 14 , 15 , 16 , 17 ].…”

Section: Methodsmentioning

confidence: 99%

Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

et al. 2021

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Background. Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. Methods. We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodiscitis (one). Results. Automatic registration, applying intraoperative CT, resulted in high accuracy (target registration error: 0.84 ± 0.10 mm). The effective radiation dose of the registration CT scans was 6.16 ± 3.91 mSv. In seven patients, a control iCT scan was performed for resection and implant control, with an ED of 4.51 ± 2.48 mSv. Augmented reality (AR) was used to support surgery in 11 cases, by visualizing the tumor outline, pedicle screws, herniated discs, and surrounding structures. Of the 16 patients, corpectomy was performed in six patients with the implantation of an expandable cage, and one patient underwent discectomy using the XLIF technique. One patient experienced perioperative complications. One patient died in the early postoperative course due to severe cardiorespiratory failure. Ten patients had improved and five had unchanged neurological status at the 3-month follow up. Conclusions. Intraoperative computed tomography with navigation facilitates the application of lateral approaches to the spine for a variety of indications, including fusion procedures, tumor resection, and herniated disc surgery.

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“…The same authors showed that the techniques currently employed in cranial surgery for HUD can be applied to spine tumor surgery (35). In a separate publication, they demonstrated that intraoperative CT can be used with a low-dose protocol for AR registration in spine cases with registration errors of less than 1 cm and 70% decrease in overall radiation exposure, which can further facilitate AR usage in spine surgery (36).…”

Section: Workflows For Registrationmentioning

confidence: 99%

Current innovation in virtual and augmented reality in spine surgery

Yuk

Maragkos

Sato³

et al. 2021

Ann Transl Med

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In spinal surgery, outcomes are directly related both to patient and procedure selection, as well as the accuracy and precision of instrumentation placed. Poorly placed instrumentation can lead to spinal cord, nerve root or vascular injury. Traditionally, spine surgery was performed by open methods and placement of instrumentation under direct visualization. However, minimally invasive surgery (MIS) has seen substantial advances in spine, with an ever-increasing range of indications and procedures. For these reasons, novel methods to visualize anatomy and precisely guide surgery, such as intraoperative navigation, are extremely useful in this field. In this review, we present the recent advances and innovations utilizing simulation methods in spine surgery. The application of these techniques is still relatively new, however quickly being integrated in and outside the operating room. These include virtual reality (VR) (where the entire simulation is virtual), mixed reality (MR) (a combination of virtual and physical components), and augmented reality (AR) (the superimposition of a virtual component onto physical reality). VR and MR have primarily found applications in a teaching and preparatory role, while AR is mainly applied in hands-on surgical settings. The present review attempts to provide an overview of the latest advances and applications of these methods in the neurosurgical spine setting.

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Augmented reality in intradural spinal tumor surgery

Cited by 64 publications

References 36 publications

Intraoperative 3-dimensional Projection of Blood Vessels on Body Surface Using an Augmented Reality System

Intraoperative 3-dimensional Projection of Blood Vessels on Body Surface Using an Augmented Reality System

Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

Current innovation in virtual and augmented reality in spine surgery

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