Expanding Educational Frontiers in Neurosurgery: Current and Future Uses of Augmented Reality

Olexa, Joshua; Cohen, Jonathan D.; Alexander, Tyler; Brown, Cole; Schwartzbauer, Gary; Woodworth, Graeme F.

doi:10.1227/neu.0000000000002199

Cited by 17 publications

(15 citation statements)

References 23 publications

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“…AR has emerged as a promising technology, gaining considerable traction in the field of neurosurgery with a range of applications in neuroanatomy education, surgical training, and intraoperative guidance. [ 1 , 5 ]…”

Section: Discussionmentioning

confidence: 99%

Case report: Use of markerless augmented reality system for ventriculoperitoneal shunt placement

Olexa,

Trang,

Flessner

et al. 2023

Surgical Neurology International

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Background: Ventriculoperitoneal (VP) shunt placement is one of the most commonly performed neurosurgical procedures, yet failure rates remain very high. Surface landmarks are typically used to guide VP shunt placement, but they are not reliable in identifying the target anatomy. Augmented reality (AR) is a promising new technology that has the potential to improve the accuracy and effectiveness of neurosurgical procedures. We describe the use of AR for the surgical planning of a VP shunt. Case Description: A 62-year-old male with a history of subarachnoid hemorrhage presented with delayed hydrocephalus. A computed tomography scan was obtained that confirmed dilated ventricles, requiring a right VP shunt. The patient was brought to the operating room, where the AR system was used for visualization and planning. Conclusion: In this study, we describe the use of AR for VP shunt placement. The AR system consists of a Microsoft HoloLens 2 head-mounted display and a novel markerless registration system, which was used to register patient-specific 3D models onto the patient’s head for visualizing target anatomy and planning an operative approach. The AR system was used to plan the VP shunt placement in the operating room. This system is easy to use and provides a visualization of the patient’s anatomy, which can be used to plan an optimal trajectory. We believe that this has the potential to improve the accuracy and outcomes of VP shunt placements, and further studies are needed to characterize the system’s accuracy and benefits.

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Section: Discussionmentioning

confidence: 99%

Case report: Use of markerless augmented reality system for ventriculoperitoneal shunt placement

Olexa,

Trang,

Flessner

et al. 2023

Surgical Neurology International

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“…Modeling and adequate professional training, according to the Institute of Medicine, are the keys to comprising a total for successful collaborative practice [ 26 – 29 ]. The authors are purposely [ 6 ] assessing the impact of AR on surgical and clinical outcomes.…”

Section: Vr and Ar In Medical Educationmentioning

confidence: 99%

Virtual and augmented reality in biomedical engineering

Taghian,

Abo-Zahhad,

Sayed

et al. 2023

BioMed Eng OnLine

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Background In the future, extended reality technology will be widely used. People will be led to utilize virtual reality (VR) and augmented reality (AR) technologies in their daily lives, hobbies, numerous types of entertainment, and employment. Medical augmented reality has evolved with applications ranging from medical education to picture-guided surgery. Moreover, a bulk of research is focused on clinical applications, with the majority of research devoted to surgery or intervention, followed by rehabilitation and treatment applications. Numerous studies have also looked into the use of augmented reality in medical education and training. Methods Using the databases Semantic Scholar, Web of Science, Scopus, IEEE Xplore, and ScienceDirect, a scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. To find other articles, a manual search was also carried out in Google Scholar. This study presents studies carried out over the previous 14 years (from 2009 to 2023) in detail. We classify this area of study into the following categories: (1) AR and VR in surgery, which is presented in the following subsections: subsection A: MR in neurosurgery; subsection B: spine surgery; subsection C: oral and maxillofacial surgery; and subsection D: AR-enhanced human-robot interaction; (2) AR and VR in medical education presented in the following subsections; subsection A: medical training; subsection B: schools and curriculum; subsection C: XR in Biomedicine; (3) AR and VR for rehabilitation presented in the following subsections; subsection A: stroke rehabilitation during COVID-19; subsection B: cancer and VR, and (4) Millimeter-wave and MIMO systems for AR and VR. Results In total, 77 publications were selected based on the inclusion criteria. Four distinct AR and/or VR applications groups could be differentiated: AR and VR in surgery (N = 21), VR and AR in Medical Education (N = 30), AR and VR for Rehabilitation (N = 15), and Millimeter-Wave and MIMO Systems for AR and VR (N = 7), where N is number of cited studies. We found that the majority of research is devoted to medical training and education, with surgical or interventional applications coming in second. The research is mostly focused on rehabilitation, therapy, and clinical applications. Moreover, the application of XR in MIMO has been the subject of numerous research. Conclusion Examples of these diverse fields of applications are displayed in this review as follows: (1) augmented reality and virtual reality in surgery; (2) augmented reality and virtual reality in medical education; (3) augmented reality and virtual reality for rehabilitation; and (4) millimeter-wave and MIMO systems for augmented reality and virtual reality.

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“…Over the past several years, AR has emerged as a promising technology, gaining considerable traction in neurosurgery and orthopedic surgery [6][7][8]. Unlike VR, in which views of the real-world environment are lost, AR enables users to experience computer-generated content (i.e., holograms) in the real world by merging virtual data such as three-dimensional (3D) anatomy or virtual tools with the real environment [9,10].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of a novel augmented reality overlay for cervical screw placement in phantom spine models

Olexa,

Shear,

Han

et al. 2024

Asian Spine J

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A phantom model was used to evaluate the accuracy of a novel augmented reality (AR) system for cervical screw placement. Overview of Literature: The use of navigation systems is becoming increasingly common in spine procedures. However, numerous factors limit the feasibility of regular and widespread use of navigation tools during spine surgery. AR is a new technology that has already demonstrated utility as a navigation tool during spine surgery. However, advancements in AR technology are needed to increase its adoption by the medical community. Methods: AR technology that uses a fiducial-less registration system was tested in a preclinical cervical spine phantom model study for accuracy during spinal screw placement. A three-dimensional reconstruction of the spine along with trajectory lines was superimposed onto the phantom model using an AR headset. Participants used the AR system to guide screw placement, and post-instrumentation scans were compared for accuracy assessment. Results: Twelve cervical screws were placed under AR guidance. All screws were placed in an acceptable anatomic position. The average distance error for the insertion point was 2.73±0.55 mm, whereas that for the endpoint was 2.71±0.69 mm. The average trajectory angle error for all insertions was 2.69°±0.59°. Conclusions: This feasibility study describes a novel registration approach that superimposes spinal anatomy and trajectories onto the surgeon's real-world view of the spine. These results demonstrate reasonable accuracy in the preclinical model. The results of this study demonstrate that this technology can assist with accurate screw placement. Further investigation using cadaveric and clinical models is warranted.

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Expanding Educational Frontiers in Neurosurgery: Current and Future Uses of Augmented Reality

Cited by 17 publications

References 23 publications

Case report: Use of markerless augmented reality system for ventriculoperitoneal shunt placement

Case report: Use of markerless augmented reality system for ventriculoperitoneal shunt placement

Virtual and augmented reality in biomedical engineering

Feasibility of a novel augmented reality overlay for cervical screw placement in phantom spine models

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