Intraoperative Augmented Reality in Microsurgery for Intracranial Arteriovenous Malformation: A Case Report and Literature Review

Abstract

Background: Intracranial arteriovenous malformations (AVMs) are lesions containing complex vessels with a lack of buffering capillary architecture which might result in hemorrhagic cerebrovascular accidents (CVAs). Intraoperative navigation can improve resection rates and functional preservation in patients with lesions in eloquent areas, but current systems have limitations that can distract the operator. Augmented Reality (AR) surgical technology can reduce these distractions and provide real-time information regarding vascular morphology and location. Methods: In this case report, an adult patient was admitted to the emergency department after a fall, and diagnostic imaging revealed a Spetzler–Martin grade I AVM in the right parietal region with evidence of rupture. The patient underwent a stereotactic microsurgical resection with assistance from augmented reality technology, which allowed for a hologram of the angioarchitecture to be projected onto the cortical surface, aiding in the recognition of the angiographic anatomy during surgery. Results: The patient’s postoperative recovery went smoothly. At 6-month follow-up, the patient had remained in stable condition, experiencing complete relief from his previous symptoms. The follow-up examination also revealed complete obliteration of the AVMs without any remaining pathological vascular structure. Conclusions: AR-assisted microsurgery makes both the dissection and resection steps safer and more delicate. As several innovations are occurring in AR technology today, it is likely that this novel technique will be increasingly adopted in both surgical applications and education. Although certain limitations exist, this technique may still become more efficient and precise as this novel technology its continues to develop further.

Pediatric Cerebral Vascular Malformations : Current and Future Perspectives

“…Intraoperative tools to enhance visualization, such as the exoscope and high-fidelity ultrasound, have added to the armamentarium available to surgeons managing these conditions [ 31 , 33 ]. Lastly, the growing field of augmented and virtual reality offers surgeons and interventional radiologists a new way of interacting with imaging to better plan and perform treatments which is particularly germane to the complex three-dimensional anatomy of cerebrovascular lesions [ 9 , 29 ].…”

Augmented Reality in Neurosurgery: A New Paradigm for Training

“…Presently, AR is most commonly used in neurosurgery for neurovascular pathologies [17], followed by neuro-oncological pathologies and non-vascular and non-neoplastic lesions [12]. AR has been utilized in cerebrovascular neurosurgery to provide assistance with the treatment of arteriovenous malformations (AVMs) [18], cerebral aneurysms [19], and extracranial-intracranial bypass revascularization surgery [20]. Intracranial AVMs are lesions containing pathological connections between arteries and veins in the brain.…”

“…AR has the potential to guide surgeons in navigating the complex AVM vasculature to treat patients without causing damage to the normal surrounding vasculature. In a case report detailing a patient with a ruptured right parietal Spetzler-Martin grade I AVM secondary to a mechanical fall, AR was used to project a hologram of the angioarchitecture on the surface of the cortex, providing in the object recognition an image of the angiographic anatomy during surgery [18]. Six months after the procedure, the AVM was completely obliterated and the patient experienced complete relief of symptoms, demonstrating that AR-assisted microsurgery can improve the safety and efficacy of AVM resection [18].…”

“…In a case report detailing a patient with a ruptured right parietal Spetzler-Martin grade I AVM secondary to a mechanical fall, AR was used to project a hologram of the angioarchitecture on the surface of the cortex, providing in the object recognition an image of the angiographic anatomy during surgery [18]. Six months after the procedure, the AVM was completely obliterated and the patient experienced complete relief of symptoms, demonstrating that AR-assisted microsurgery can improve the safety and efficacy of AVM resection [18]. Surgical intervention for the treatment of cerebral aneurysms is similar to that of AVMs in the sense that surgery must be conducted in a highly precise manner to avoid damaging the surrounding vasculature.…”

“…Li et al [18] Right parietal AVM with evidence of rupture Microresection of AVM was conducted with an AR holographic projection of angiographic architecture projected onto the cortical surface.…”