Stereotactic co-axial projection imaging for augmented reality neuronavigation: a proof-of-concept study

Abstract

Background: Lack of intuitiveness and poor hand-eye coordination present a major technical challenge in neurosurgical navigation. Methods:We developed an integrated dexterous stereotactic co-axial projection imaging (sCPI) system featuring orthotopic image projection for augmented reality (AR) neurosurgical navigation. The performance characteristics of the sCPI system, including projection resolution and navigation accuracy, were quantitatively verified. The resolution of the sCPI was tested with a USAF1951 resolution test chart.The stereotactic navigation accuracy of the sCPI was measured using a calibration panel with a 7×7 circle array pattern. In benchtop validation, the navigation accuracy of the sCPI and the BrainLab Kick Navigation Station was compared using a skull phantom with 8 intracranial targets. Finally, we demonstrated the potential clinical application of sCPI through a clinical trial. Results:The resolution test showed that the resolution of the sCPI was 1.3 mm. In a stereotactic navigation accuracy test, the maximum and minimum error of the sCPI was 2.9 and 0.3 mm, and the mean error was 1.5 mm. The stereotactic navigation accuracy test also showed that the navigation error of the sCPI would increase with the pitch and yaw angle, but there was no obvious difference in navigation errors caused by different yaw directions, which meant that the navigation error is unbiased across all directions. The benchtop validation showed that the average navigation errors for the sCPI system and the Kick Navigation Station were 1.4±0.8 and 1.8±0.7 mm, the medians were 1.3 and 1.9 mm, and the average preparation times were 3 min 24 sec and 6 min 8 sec, respectively. The clinical feasibility of sCPI-assisted neurosurgical navigation was demonstrated in a clinical study. In comparison with the BrainLab device, the sCPI system required less time for preoperative preparation and enhanced the clinician experience in intraoperative visualization and navigation. Conclusions:The sCPI technique can be potentially used in many surgical applications for intuitive visualization of medical information and intraoperative guidance of surgical trajectories.

Evaluation Metrics for Augmented Reality in Neurosurgical Preoperative Planning, Surgical Navigation, and Surgical Treatment Guidance: A Systematic Review

“…In 30 studies (38%), the use of a head-mounted device for neurosurgery was evaluated ( Supplemental Digital Content 2, Table 1 , http://links.lww.com/ONS/B48). 10-86 In most of these studies, the HoloLens (Microsoft) was used for AR visualization. In 26 studies (32%), an image overlay, for either the microscopic or endoscopic field of view, was used.…”

“…com/ONS/B49). [85][86][87][88][89][90] Based on the results of this review, the following evaluation categories have been defined: (1) registration accuracy, (2) clinical outcome, (3) time measurements, (4) task performance, (5) technical reliability, and (6) user perception (Table ).…”

Augmented and virtual reality usage in awake craniotomy: a systematic review

“…transparent displays that present data without requiring users to look away from their viewpoint), head-mounted display (i.e. devices which are worn on the head or as part of a helmet), monitor- and tablet-based visualisation, and image insertion into the surgical field, have been investigated [ 3 , 13 , 14 , 19 , 30 , 39 , 47 , 49 , 62 , 73 , 81 , 93 ].…”

Augmented and Virtual Reality Usage in Awake Craniotomy: A Systematic Review

“…Multiple AR-based approaches, such as image projection, head-up display (i.e., transparent displays that present data without requiring users to look away from their viewpoint), head-mounted display (i.e., devices which are worn on the head or as part of a helmet), monitor-and tablet-based visualisation, and image insertion into the surgical eld have been investigated [6,17,64,[84][85][86][87][88][89][90][91][92].…”