Virtual Reality Augmentation in Skull Base Surgery

Abstract

Objective: Skull base anatomy is complex and subject to individual variation. Understanding the complexity of surgical anatomy is faster and easier with virtual models created from primary imaging data of the patient. This study was designed to investigate the usefulness of virtual reality in image guidance for skull base procedures. Design: Primary volumetric image data from 110 patients was acquired using magnetic resonance, computed tomography (CT), and CT angiography. Pathologies included lesions in the anterior, middle, and posterior skull base. The data were transferred to an infrared-based image-guidance system for creation of a virtual operating field (VOF) with translucent surface modulation and optional ''fly-through'' video mode. During surgery, the target registration error for anatomical landmarks was assessed and the VOF was compared with the patient's anatomy in the operative field. Results: Complex structures like the course of the sigmoid sinus, the carotid artery, and the outline of the paranasal sinuses were well visualized in the VOF and were recognized by the surgeon instantly. Perception was greatly facilitated as compared with routine mental reconstruction of triaxial images. Accurate assessment of the depth of field and very small objects was not possible in VOF images. Conclusion: Supported by sound anatomical knowledge, creation of a virtual operating field for a surgical approach in an individual patient offers a déjà vu experience that can enhance the capabilities of a surgical team in skull base approaches. In addition, application of this technique in image-guided procedures assists in targeting or avoiding hidden anatomical structures.

Virtual surgical planning in endoscopic skull base surgery

“…Thus, there is a need for significant exposure of the surgical target and planning to safely and precisely remove the tumor. To fulfill such need, integrated systems for intraoperative surgical guidance have been actively investigated over the past several years, including systems that provide virtual and augmented reality surgical views in addition to standard planning (SP) . In analogy of the radiation oncologist outlining and contouring the target volume, virtual planning (VP) for surgical guidance requires accurate methods for anatomical contour delineation by using manual and/or automatic methods based on preoperative volumetric imaging.…”

“…The resulting contours can be presented to the surgeon in a 3D view for preoperative surgical planning as well for intraoperative surgical guidance. Thus, VP can help to visualize the surgical process and support the surgeon with intratreatment imaging and surgical guidance …”

Prediction of the Microsurgical Window for Skull-Base Tumors by Advanced Three-Dimensional Multi-fusion Volumetric Imaging

“…3-D imaging has found applications in various neurosurgical fields. 1,3,[5][6][7]12,13,[15][16][17] This study showed that high-quality visualization by 3-D MFVI improved the understanding of the 3-D relationships between the tumor, important vessels, brain and CNs, and skull. We employed advanced image-analysis methods such as volume rendering to reconstruct 3-D volumetric data from a sequential 2-D dataset and image fusion to integrate multiple datasets into the same data.…”

Open Anterior Skull Base Reconstruction: A Contemporary Review

“…Further volumetric manipulation of these two-dimensional multiplanar images has refined surgical planning and navigation by producing 3D images able to delineate tumor from normal tissue and highlight vital structures through color coding. 53 These advances in preoperative imaging have been able to increase the utilization of customized hardware and reconstructive planning. This is especially true in the case of bony craniofacial surgery where computer-aided manufacturing has made it possible to precisely plan osteotomies with cutting guides and easily place prebent or custom-milled plates.…”