The application of augmented reality–based navigation for accurate target acquisition of deep brain sites: advances in neurosurgical guidance

2021 ◽  
pp. 1-7
Keyword(s):  
Augmented Reality ◽  
Guidance System ◽  
Pituitary Fossa ◽  
Radial Error ◽  
Skull Model ◽  
Ballistic Gelatin ◽  
The Mean ◽  
Burr Holes ◽  
Parietal Bones ◽  
Neurological Surgery

OBJECTIVE The objective of this study is to quantify the navigational accuracy of an advanced augmented reality (AR)–based guidance system for neurological surgery, biopsy, and/or other minimally invasive neurological surgical procedures. METHODS Five burr holes were drilled through a plastic cranium, and 5 optical fiducials (AprilTags) printed with CT-visible ink were placed on the frontal, temporal, and parietal bones of a human skull model. Three 0.5-mm-diameter targets were mounted in the interior of the skull on nylon posts near the level of the tentorium cerebelli and the pituitary fossa. The skull was filled with ballistic gelatin to simulate brain tissue. A CT scan was taken and virtual needle tracts were annotated on the preoperative 3D workstation for the combination of 3 targets and 5 access holes (15 target tracts). The resulting annotated study was uploaded to and launched by VisAR software operating on the HoloLens 2 holographic visor by viewing an encrypted, printed QR code assigned to the study by the preoperative workstation. The DICOM images were converted to 3D holograms and registered to the skull by alignment of the holographic fiducials with the AprilTags attached to the skull. Five volunteers, familiar with the VisAR, used the software/visor combination to navigate an 18-gauge needle/trocar through the series of burr holes to the target, resulting in 70 data points (15 for 4 users and 10 for 1 user). After each attempt the needle was left in the skull, supported by the ballistic gelatin, and a high-resolution CT was taken. Radial error and angle of error were determined using vector coordinates. Summary statistics were calculated individually and collectively. RESULTS The combined angle of error of was 2.30° ± 1.28°. The mean radial error for users was 3.62 ± 1.71 mm. The mean target depth was 85.41 mm. CONCLUSIONS The mean radial error and angle of error with the associated variance measures demonstrates that VisAR navigation may have utility for guiding a small needle to neural lesions, or targets within an accuracy of 3.62 mm. These values are sufficiently accurate for the navigation of many neurological procedures such as ventriculostomy.

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

2021 ◽  
Author(s):  
Valentina Pennacchietti ◽  
Katharina Stoelzel ◽  
Anna Tietze ◽  
Erwin Lankes ◽  
Andreas Schaumann ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Morphological Variability ◽  
Case Series ◽  
Relevant Information ◽  
Navigation Systems ◽  
Postoperative Mri ◽  
The Mean ◽  
Clinical Conditions

Abstract Introduction Endoscopic skull base approaches are broadly used in modern neurosurgery. The support of neuronavigation can help to effectively target the lesion avoiding complications. In children, endoscopic-assisted skull base surgery in combination with navigation systems becomes even more important because of the morphological variability and rare diseases affecting the sellar and parasellar regions. This paper aims to analyze our first experience on augmented reality navigation in endoscopic skull base surgery in a pediatric case series. Patients and methods A retrospective review identified seventeen endoscopic-assisted endonasal or transoral procedures performed in an interdisciplinary setting in a period between October 2011 and May 2020. In all the cases, the surgical target was a lesion in the sellar or parasellar region. Clinical conditions, MRI appearance, intraoperative conditions, postoperative MRI, possible complications, and outcomes were analyzed. Results The mean age of our patients was 14.5 ± 2.4 years. The diagnosis varied, but craniopharyngiomas (31.2%) were mostly represented. AR navigation was experienced to be very helpful for effectively targeting the lesion and defining the intraoperative extension of the pathology. In 65% of the oncologic cases, a radical removal was proven in postoperative MRI. The mean follow-up was 89 ± 79 months. There were no deaths in our series. No long-term complications were registered; two cerebrospinal fluid (CSF) fistulas and a secondary abscess required further surgery. Conclusion The implementation of augmented reality to endoscopic-assisted neuronavigated procedures within the skull base was feasible and did provide relevant information directly in the endoscopic field of view and was experienced to be useful in the pediatric cases, where anatomical variability and rarity of the pathologies make surgery more challenging.

Augmented reality guidance system for peripheral nerve blocks

2010 ◽  
Author(s):  
Chris Wedlake ◽  
John Moore ◽  
Maxim Rachinsky ◽  
Daniel Bainbridge ◽  
Andrew D. Wiles ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Peripheral Nerve ◽  
Guidance System ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks

O-Arm–Guided Balloon Kyphoplasty: Prospective Single-Center Case Series of 54 Consecutive Patients

2011 ◽  
Vol 68 (suppl_2) ◽  
pp. ons250-ons256 ◽  
Author(s):  
Frédéric Schils
Keyword(s):  
Case Series ◽  
Balloon Kyphoplasty ◽  
Guidance System ◽  
Fluoroscopy Time ◽  
Vertebral Compression Fractures ◽  
Additional Time ◽  
Minimally Invasive Spinal Surgery ◽  
X Ray ◽  
Clinical Series ◽  
The Mean

Abstract Background: Balloon kyphoplasty is widely used to treat vertebral compression fractures. Procedure outcome and safety are directly linked to precise radiological imaging requiring 1 or 2 C arms to allow correct visualization throughout the procedure. This minimally invasive spinal surgery is associated with radiation exposure for both patient and surgeon. In our center, we switched from using a C-arm to an O-arm image guidance system to perform balloon kyphoplasty. Our preliminary experience is reported in Acta Neurochirurgica, and the encouraging results led us to study this subject more extensively. This article presents our complete results. To the best of our knowledge, there is no comparable clinical series describing O-arm use in kyphoplasty procedures published in the literature. Objective: To report our complete results of using the O-arm guidance system to perform balloon kyphoplasty. Methods: We prospectively evaluated O-arm–guided kyphoplasty procedure in 54 consecutive patients and measured x-ray exposure and fluoroscopy time. Results: The mean surgical time for the procedure was 38 minutes with a mean fluoroscopy procedure time of 3.1 minutes. The mean fluoroscopy time by level was 2.5 minutes. Mean irradiation dose by procedure was 220 mGy and by level was 166 mGy. There was a significant reduction in fluoroscopy time and x-ray exposure from 5.1 minutes with classic C-arm use to 3.1 minutes when with O-arm use without additional time required for positioning the system. Conclusion: With this new intraoperative system, the overall surgical and fluoroscopy times can be further reduced in the near future.

scholarly journals Evaluation of an augmented reality based image guidance system for laparoscopic liver surgery

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S671-S672
Author(s):  
C. Schneider ◽  
S. Thompson ◽  
K. Gurusamy ◽  
D. Stoyanov ◽  
D.J. Hawkes ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Liver Surgery ◽  
Image Guidance ◽  
Guidance System ◽  
Laparoscopic Liver Surgery

Development and Evaluation of an Augmented Reality Ultrasound Guidance System for Spinal Anesthesia: Preliminary Results

2019 ◽  
Vol 45 (10) ◽  
pp. 2736-2746 ◽  
Author(s):  
Golafsoun Ameri ◽  
Adam Rankin ◽  
John S.H. Baxter ◽  
John Moore ◽  
Sugantha Ganapathy ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Spinal Anesthesia ◽  
Ultrasound Guidance ◽  
Guidance System ◽  
Preliminary Results

scholarly journals CIGuide: in situ augmented reality laser guidance

2019 ◽  
Vol 15 (1) ◽  
pp. 49-57
Author(s):  
Zoltán Bárdosi ◽  
Christian Plattner ◽  
Yusuf Özbek ◽  
Thomas Hofmann ◽  
Srdjan Milosavljevic ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Skull Base ◽  
Visual Cues ◽  
Needle Insertion ◽  
Guidance System ◽  
Laser Guidance ◽  
End Effector ◽  
Magnetic Tracking ◽  
Lateral Skull Base

Abstract Purpose  A robotic intraoperative laser guidance system with hybrid optic-magnetic tracking for skull base surgery is presented. It provides in situ augmented reality guidance for microscopic interventions at the lateral skull base with minimal mental and workload overhead on surgeons working without a monitor and dedicated pointing tools. Methods  Three components were developed: a registration tool (Rhinospider), a hybrid magneto-optic-tracked robotic feedback control scheme and a modified robotic end-effector. Rhinospider optimizes registration of patient and preoperative CT data by excluding user errors in fiducial localization with magnetic tracking. The hybrid controller uses an integrated microscope HD camera for robotic control with a guidance beam shining on a dual plate setup avoiding magnetic field distortions. A robotic needle insertion platform (iSYS Medizintechnik GmbH, Austria) was modified to position a laser beam with high precision in a surgical scene compatible to microscopic surgery. Results  System accuracy was evaluated quantitatively at various target positions on a phantom. The accuracy found is 1.2 mm ± 0.5 mm. Errors are primarily due to magnetic tracking. This application accuracy seems suitable for most surgical procedures in the lateral skull base. The system was evaluated quantitatively during a mastoidectomy of an anatomic head specimen and was judged useful by the surgeon. Conclusion  A hybrid robotic laser guidance system with direct visual feedback is proposed for navigated drilling and intraoperative structure localization. The system provides visual cues directly on/in the patient anatomy, reducing the standard limitations of AR visualizations like depth perception. The custom- built end-effector for the iSYS robot is transparent to using surgical microscopes and compatible with magnetic tracking. The cadaver experiment showed that guidance was accurate and that the end-effector is unobtrusive. This laser guidance has potential to aid the surgeon in finding the optimal mastoidectomy trajectory in more difficult interventions.

scholarly journals Medical Augmented-Reality Visualizer for Surgical Training and Education in Medicine

2019 ◽  
Vol 9 (13) ◽  
pp. 2732 ◽  
Author(s):  
Radosław Gierwiało ◽  
Marcin Witkowski ◽  
Maciej Kosieradzki ◽  
Wojciech Lisik ◽  
Łukasz Groszkowski ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Spatial Perception ◽  
Spatial Relationship ◽  
Guidance System ◽  
Training And Education ◽  
3D Perception ◽  
Augmented Reality System ◽  
Internal Structures ◽  
Medical Augmented Reality ◽  
Liver Phantom

This paper presents a projection-based augmented-reality system (MARVIS) that supports the visualization of internal structures on the surface of a liver phantom. MARVIS is endowed with three key features: tracking of spatial relationship between the phantom and the operator’s head in real time, monoscopic projection of internal liver structures onto the phantom surface for 3D perception without additional head-mounted devices, and phantom internal electronic circuit to assess the accuracy of a syringe guidance system. An initial validation was carried out by 25 medical students (12 males and 13 females; mean age, 23.12 years; SD, 1.27 years) and 3 male surgeons (mean age, 43.66 years; SD, 7.57 years). The validation results show that the ratio of failed syringe insertions was reduced from 50% to 30% by adopting the MARVIS projection. The proposed system suitably enhances a surgeon’s spatial perception of a phantom internal structure.

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