Augmented Reality Surgical Navigation System for External Ventricular Drain

Abstract

Augmented reality surgery systems are playing an increasing role in the operating room, but applying such systems to neurosurgery presents particular challenges. In addition to using augmented reality technology to display the position of the surgical target position in 3D in real time, the application must also display the scalpel entry point and scalpel orientation, with accurate superposition on the patient. To improve the intuitiveness, efficiency, and accuracy of extra-ventricular drain surgery, this paper proposes an augmented reality surgical navigation system which accurately superimposes the surgical target position, scalpel entry point, and scalpel direction on a patient’s head and displays this data on a tablet. The accuracy of the optical measurement system (NDI Polaris Vicra) was first independently tested, and then complemented by the design of functions to help the surgeon quickly identify the surgical target position and determine the preferred entry point. A tablet PC was used to display the superimposed images of the surgical target, entry point, and scalpel on top of the patient, allowing for correct scalpel orientation. Digital imaging and communications in medicine (DICOM) results for the patient’s computed tomography were used to create a phantom and its associated AR model. This model was then imported into the application, which was then executed on the tablet. In the preoperative phase, the technician first spent 5–7 min to superimpose the virtual image of the head and the scalpel. The surgeon then took 2 min to identify the intended target position and entry point position on the tablet, which then dynamically displayed the superimposed image of the head, target position, entry point position, and scalpel (including the scalpel tip and scalpel orientation). Multiple experiments were successfully conducted on the phantom, along with six practical trials of clinical neurosurgical EVD. In the 2D-plane-superposition model, the optical measurement system (NDI Polaris Vicra) provided highly accurate visualization (2.01 ± 1.12 mm). In hospital-based clinical trials, the average technician preparation time was 6 min, while the surgeon required an average of 3.5 min to set the target and entry-point positions and accurately overlay the orientation with an NDI surgical stick. In the preparation phase, the average time required for the DICOM-formatted image processing and program import was 120 ± 30 min. The accuracy of the designed augmented reality optical surgical navigation system met clinical requirements, and can provide a visual and intuitive guide for neurosurgeons. The surgeon can use the tablet application to obtain real-time DICOM-formatted images of the patient, change the position of the surgical entry point, and instantly obtain an updated surgical path and surgical angle. The proposed design can be used as the basis for various augmented reality brain surgery navigation systems in the future.

A Novel Registration Method for a Mixed Reality Navigation System Based on a Laser Crosshair Simulator: A Technical Note

“…The substantial, expensive hardware systems and complex workflows challenge the widespread adoption of microscope-based navigation. Hence, there has been increasing interest in smaller, low-cost, and easy-to-use alternatives for AR-guided interventions, such as projector-based [18,19], smartphone-based [20][21][22][23][24], tablet-based [22,[25][26][27], and head-mounted display (HMD)-based AR [7,8,10,28]. These AR paradigms are widely used as "low-cost navigation" in underdeveloped regions or healthcare facilities with limited resources.…”

Augmented Reality Integration in Skull Base Neurosurgery: A Systematic Review

“…Overall, the primary areas of neurosurgery where AR is most extensively applied include spinal surgery, NN, and education [6,51]. Its application is also beneficial in hydrocephalus surgery [52], neuroimaging [53,54], surgery for brain tumors [55], cerebrovascular pathology [56], ventricular system surgery [57], neurotrauma [58], and neurodegenerative pathology [59].…”

IMAGINER: improving accuracy with a mixed reality navigation system during placement of external ventricular drains. A feasibility study

“…Unlike previous studies, our feasibility study is the first to demonstrate the impact of real-time visualization of the catheter position in corresponding 2D MRI slices using the Microsoft HoloLens. 11,21,22 Ventriculostomy and EVD placement are among the most common procedures in neurosurgery and are usually among the first procedures performed by inexperienced neurosurgical residents. The most common technique of ventricular puncture is freehand placement according to the predefined external anatomical landmarks (Kocher's point, ipsilateral medial canthus, and external auditory canal).…”