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

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.

The intraoperative use of augmented and mixed reality technology to improve surgical outcomes: A systematic review

“…In a series of 11 patients, including 10 children, undergoing various AR‐guided skull base surgeries, three (27.3%) patients suffered postoperative complications, while the mean time spent in inpatient care was 8.6 ± 4.7 days 46 …”

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

“…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 ]. For cranial neurosurgery, besides the applications of AR in phantom studies or for preoperative simulations and training, the first descriptions of intraoperative use can also be found (AR-assisted navigation) [ 9 , 16 , 18 , 25 ]. The development of AR glasses provides another pioneering field, allowing the surgeon to move around in the room and view an object from all sides or even walk through it.…”

“…With regard to applications in cranial neurosurgery, various AR-based simulations for cerebrovascular, brain tumor, and skull base procedures have been described so far [ 2 , 11 , 18 , 31 , 39 ], as have AR-supported training concepts in brain tumor and skull base surgery [ 16 , 19 , 32 ]. 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 ].…”

Image-guided surgery and novel intraoperative devices for enhanced visualisation in general and paediatric surgery: a review

“…described intraoperative AR in a neuronavigation setting, which may be easier to implement with more fixed spatial anatomical relationships in head and neck surgery than abdominal surgery. Despite the difficulty in interpreting the results due to the lack of controls for comparison of patient outcomes, the authors stress the accuracy of the AR system intraoperatively, especially in identifying anatomical landmarks to better execute the surgical plan and its reproducibility [ 48 ].…”