Augmented reality navigation for cranial biopsy and external ventricular drain insertion

Abstract

OBJECTIVE The aim of this study was to evaluate the accuracy (deviation from the target or intended path) and efficacy (insertion time) of an augmented reality surgical navigation (ARSN) system for insertion of biopsy needles and external ventricular drains (EVDs), two common neurosurgical procedures that require high precision. METHODS The hybrid operating room–based ARSN system, comprising a robotic C-arm with intraoperative cone-beam CT (CBCT) and integrated video tracking of the patient and instruments using nonobtrusive adhesive optical markers, was used. A 3D-printed skull phantom with a realistic gelatinous brain model containing air-filled ventricles and 2-mm spherical biopsy targets was obtained. After initial CBCT acquisition for target registration and planning, ARSN was used for 30 cranial biopsies and 10 EVD insertions. Needle positions were verified by CBCT. RESULTS The mean accuracy of the biopsy needle insertions (n = 30) was 0.8 mm ± 0.43 mm. The median path length was 39 mm (range 16–104 mm) and did not correlate to accuracy (p = 0.15). The median device insertion time was 149 seconds (range 87–233 seconds). The mean accuracy for the EVD insertions (n = 10) was 2.9 mm ± 0.8 mm at the tip with a 0.7° ± 0.5° angular deviation compared with the planned path, and the median insertion time was 188 seconds (range 135–400 seconds). CONCLUSIONS This study demonstrated that ARSN can be used for navigation of percutaneous cranial biopsies and EVDs with high accuracy and efficacy.

Development of a CT-Compatible, Anthropomorphic Skull and Brain Phantom for Neurosurgical Planning, Training, and Simulation

“…The final prototype was assessed by experienced neurosurgeons, who found the head phantom to meet the expectations of both anatomical and surgical realism. A detailed quantitative assessment of the model with respect to the simulated surgical outcomes has been reported in a previous study [ 20 ].…”

“…To achieve authenticity and maintain low costs, the materials used for production were carefully selected, and tested in different concentrations and compositions to match criteria formulated from published data. In addition, the model was tested and evaluated by neurosurgeons for representativity and utility [ 20 ].…”

“…By virtue of its realistic imaging properties, the phantom can be used in the development and testing of navigation solutions that require imaging-based set-ups. In fact, the phantom has recently been used to test the accuracy and efficacy of an augmented reality-based surgical navigation system for brain biopsies or EVD placement [ 20 ]. This use of the phantom provides a safe and cost-effective approach to evaluate experimental tools and solutions [ 27 ].…”

Augmented reality–assisted craniofacial reconstruction in skull base lesions — an innovative technique for single-step resection and cranioplasty in neurosurgery

“…Phantom studies and cadaver simulations have also demonstrated promising applications of AR in cranial neurosurgery with techniques for cranial biopsy or accurate catheter placement. This raises the potential for very precise minimally invasive procedures, which could perspectively be applied bedside with minor efforts [ 33 , 36 ]. AR-assisted puncture of the gasserian ganglion for precise radiofrequency ablation in trigeminal neuralgia provides another interesting approach in minimally invasive interventional pain management [ 26 ].…”

“…As for intraoperative use, descriptions of AR-guided navigation can be found primarily for endoscopic procedures, including endoscopic transsphenoidal skull base surgery [ 9 , 25 , 29 ]. Several phantom studies also demonstrate potential applications for cranial biopsy or catheter placement [ 33 , 36 ].…”