Extended reality platform for minimally invasive endoscopic evacuation of deep-seated intracerebral hemorrhage: illustrative case

Abstract

BACKGROUND Extended reality (XR) offers an interactive visualization platform that combines virtual reality (VR) for preoperative planning and augmented reality (AR) for intraoperative navigation overlay. OBSERVATIONS XR was used for treating a case of spontaneous intracerebral hemorrhage (ICH) requiring neurosurgical intervention to decompress a hemorrhage in the subcortical area involving the thalamus that was starting to compress the midbrain. The selected surgical technique was an endoscopic aspiration combined with neurosurgical navigation. Because of the deep-seated location of this ICH, a patient-specific 360XR model rendered using Surgical Theater was used for preoperative planning and intraoperative navigation to allow for enhanced visualization and understanding of the pathology and surrounding anatomy. LESSONS The XR platform enabled visualization of critical structures near the ICH by extracting and highlighting the white matter tracts from magnetic resonance imaging (MRI) with tractography, which improved preoperative planning beyond using state-of-the-art neuronavigation techniques alone. Once the trajectory was set, the model was integrated with the neuronavigation system, and the planned approach was referenced throughout the procedure to evacuate the clots without further injuring the brain. The patient tolerated the procedure well and was doing well 11 months after his spontaneous ICH.

Does Extended Reality Simulation Improve Surgical/Procedural Learning and Patient Outcomes When Compared With Standard Training Methods?

“…For time to task completion and technical scores, XR enhances procedural accuracy and surgical confidence by facilitating a deeper understanding of the patient's anatomy. 21 The integration of XR in surgical procedures holds potential therapeutic benefits, particularly for complex cases [18][19][20]54,55 because the learning curve is high. There is evidence that learning curves for complex procedures can be mitigated with repetition and motivation 56 and intelligent tutoring systems.…”

An endoscopic-assisted contralateral paramedian supracerebellar infratentorial approach in the treatment of thalamic hemorrhage with hematoma extension into the brainstem: a case report

“…Intracerebral hemorrhage accounts for 6.5%–19.6% of stroke cases ( 1 ), and approximately 15% of these cases occur in the thalamus ( 2 ). The clinical manifestations and prognosis of thalamic hemorrhage (TH) are related to the size of the hemorrhagic lesion, the direction of the hematoma expansion, and whether it breaches the ventricle.…”