Use of Neuronavigation and Augmented Reality in Transsphenoidal Pituitary Adenoma Surgery

Abstract

The aim of this study was to report on the clinical experience with microscope-based augmented reality (AR) in transsphenoidal surgery compared to the classical microscope-based approach. AR support was established using the head-up displays of the operating microscope, with navigation based on fiducial-/surface- or automatic intraoperative computed tomography (iCT)-based registration. In a consecutive single surgeon series of 165 transsphenoidal procedures, 81 patients underwent surgery without AR support and 84 patients underwent surgery with AR support. AR was integrated straightforwardly within the workflow. ICT-based registration increased AR accuracy significantly (target registration error, TRE, 0.76 ± 0.33 mm) compared to the landmark-based approach (TRE 1.85 ± 1.02 mm). The application of low-dose iCT protocols led to a significant reduction in applied effective dosage being comparable to a single chest radiograph. No major vascular or neurological complications occurred. No difference in surgical time was seen, time to set-up patient registration prolonged intraoperative preparation time on average by twelve minutes (32.33 ± 13.35 vs. 44.13 ± 13.67 min), but seems justifiable by the fact that AR greatly and reliably facilitated surgical orientation and increased surgeon comfort and patient safety, not only in patients who had previous transsphenoidal surgery but also in cases with anatomical variants. Automatic intraoperative imaging-based registration is recommended.

Evaluation Metrics for Augmented Reality in Neurosurgical Preoperative Planning, Surgical Navigation, and Surgical Treatment Guidance: A Systematic Review

“…In 30 studies (38%), the use of a head-mounted device for neurosurgery was evaluated ( Supplemental Digital Content 2, Table 1 , http://links.lww.com/ONS/B48). 10-86 In most of these studies, the HoloLens (Microsoft) was used for AR visualization. In 26 studies (32%), an image overlay, for either the microscopic or endoscopic field of view, was used.…”

“…Most of the studies reported on multiple evaluation metrics ( Supplemental Digital Content 3, Table 2 , http://links.lww.com/ONS/B49). 10-83,85-90 Based on the results of this review, the following evaluation categories have been defined: (1) registration accuracy, (2) clinical outcome, (3) time measurements, (4) task performance, (5) technical reliability, and (6) user perception (Table).…”

“…In four studies (5%), an AR application for preoperative visualization of imaging data was described ( Supplemental Digital Content 4, Table 3 , http://links.lww.com/ONS/B50). 10-83,85-90 Their most frequently described evaluation metrics were user perception metrics (Table). Clinical outcome was mentioned in one study.…”

Comparison of the efficacy of neuronavigation-assisted intracerebral haematoma puncture and drainage with neuroendoscopic haematoma removal in the treatment of hypertensive cerebral haemorrhage

“…In recent years, neuronavigation has reduced the incidence of surgical complications by integrating computer technology and neuroimaging technology to design the optimal surgical approach, accurately locate the bleeding foci and reduce brain tissue damage to important structures. As a result, it has been widely used in the clinical management of HICH in recent years and has greatly improved the prognosis of patients [14][15] . Neuroguided endoscopic haematoma removal is also becoming more accepted by neurosurgeons as a mainstream procedure.…”

Efficacy of a Novel Augmented Reality Navigation System Using 3D Computer Graphic Modeling in Endoscopic Transsphenoidal Surgery for Sellar and Parasellar Tumors

“…Furthermore, neuronavigation occasionally has a margin of error that causes difficulties in immediate decision making. To resolve the ambiguity associated with the discrepancy between the visual image of the actual surgical field and the 2D preoperative radiographic images, a three-dimensional computer graphic (3DCG) model that uses the patient’s radiographic images has been developed and is becoming accepted for clinical use [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”