Use of Mixed Reality Visualization in Endoscopic Endonasal Skull Base Surgery

Abstract

BACKGROUND Neuronavigation systems assist with spatial orientation during endoscopic transnasal skull base surgery, but they require a correlation of 3-dimensional (3D) views with 2-dimensional (2D) radiology studies. OBJECTIVE To outline an initial experience with a novel technology platform that provides intraoperative navigation using 3D reconstructions of patient anatomy for endoscopic surgery. METHODS A retrospective study of endoscopic anterior skull base and complex paranasal procedures was performed. Data from preoperative computed tomography and magnetic resonance imaging scans were fused to create 3D digital models of patient anatomy. Using the technology developed by Surgical Theater (Mayfield Village, Ohio), these reconstructions were designed to highlight particular anatomic regions of interest. The models were studied to guide the surgical approach and anticipate critical structures. The reconstructions were linked with the navigational technology created by Brainlab (Munich, Germany) during endoscopic surgery. A dynamic image of the reconstruction was displayed alongside a matching endoscopic camera view. These 2 views could be overlaid to provide an immersive, mixed reality image of the patient's anatomy. RESULTS A total of 134 cases were performed. The pathologies included tumors of the anterior skull base or sinonasal cavity, inflammatory sinus disease, and cerebrospinal fluid leaks. Specific anatomic structures, such as the internal carotid arteries and optic nerves, were chosen for enhancement. Surgeons felt that the technology helped to guide the extent of bony dissection and to identify critical structures. CONCLUSION We describe the first clinical series of complex skull base pathologies treated using a novel mixed reality platform.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…Recently, IGS systems have introduced new technology. IGS with virtual reality features has been described 2139 . Augmented reality features have been incorporated into IGS systems 2140 .…”

First experience with augmented reality neuronavigation in endoscopic assisted midline skull base pathologies in children

“…The latest applications of AR in cranial surgery even include calvarial remodeling in children with craniosynostosis [15] and vascular neurosurgery [23]. To date, the use of AR in endoscopic transnasal approaches has been studied only in ENT surgeries [3,30,31]. As already described by Winne et al [30] from the ENT's point of view, overlay visualization of the elaborated surgical target and the navigation-calibrated endoscope represent a valuable and safe instrument to improve the surgical performances in endoscopic endonasal procedures.…”

“…The largest cohort consisting of 313 adult patients was described by Caversaccio et al [3] and was mainly composed of nasal pathologies. A more recent study covers 134 anterior skull base endoscopic procedures (from pituitary adenomas to sinusal pathologies) in an adult population [31]. Other authors focus their preliminary work on cadaveric studies of 14 and 15 specimens, respectively, in which endoscopic endonasal approaches were combined to the use of an AR navigation tool [9,20].…”

Image-Guided Surgery and Intraoperative Imaging in Rhinology: Clinical Update and Current State of the Art

“…Although the IGS core concepts have not changed since its introduction in the late 1980s and early 1990s, many improvements in the user interface have enhanced usability. Recent advancements include CT, MRI fusion capability, 23 three-dimensional (3-D) CT angiography, 24 preoperative planning software, virtual reality (VR) tools, 25 and augmented reality (AR) capabilities. 26,27 The ensuing sections will further delve into the recent advances and potential of IGS during ESS and skull base surgery.…”