Augmented reality visualization in brain lesions: a prospective randomized controlled evaluation of its potential and current limitations in navigated microneurosurgery.
Augmented reality
Brain tumors
Intraoperative visualization
Navigated microscope
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
received:
21
03
2021
accepted:
01
09
2021
pubmed:
15
12
2021
medline:
27
1
2022
entrez:
14
12
2021
Statut:
ppublish
Résumé
Augmented reality (AR) has the potential to support complex neurosurgical interventions by including visual information seamlessly. This study examines intraoperative visualization parameters and clinical impact of AR in brain tumor surgery. Fifty-five intracranial lesions, operated either with AR-navigated microscope (n = 39) or conventional neuronavigation (n = 16) after randomization, have been included prospectively. Surgical resection time, duration/type/mode of AR, displayed objects (n, type), pointer-based navigation checks (n), usability of control, quality indicators, and overall surgical usefulness of AR have been assessed. AR display has been used in 44.4% of resection time. Predominant AR type was navigation view (75.7%), followed by target volumes (20.1%). Predominant AR mode was picture-in-picture (PiP) (72.5%), followed by 23.3% overlay display. In 43.6% of cases, vision of important anatomical structures has been partially or entirely blocked by AR information. A total of 7.7% of cases used MRI navigation only, 30.8% used one, 23.1% used two, and 38.5% used three or more object segmentations in AR navigation. A total of 66.7% of surgeons found AR visualization helpful in the individual surgical case. AR depth information and accuracy have been rated acceptable (median 3.0 vs. median 5.0 in conventional neuronavigation). The mean utilization of the navigation pointer was 2.6 × /resection hour (AR) vs. 9.7 × /resection hour (neuronavigation); navigation effort was significantly reduced in AR (P < 0.001). The main benefit of HUD-based AR visualization in brain tumor surgery is the integrated continuous display allowing for pointer-less navigation. Navigation view (PiP) provides the highest usability while blocking the operative field less frequently. Visualization quality will benefit from improvements in registration accuracy and depth impression. DRKS00016955.
Sections du résumé
BACKGROUND
Augmented reality (AR) has the potential to support complex neurosurgical interventions by including visual information seamlessly. This study examines intraoperative visualization parameters and clinical impact of AR in brain tumor surgery.
METHODS
Fifty-five intracranial lesions, operated either with AR-navigated microscope (n = 39) or conventional neuronavigation (n = 16) after randomization, have been included prospectively. Surgical resection time, duration/type/mode of AR, displayed objects (n, type), pointer-based navigation checks (n), usability of control, quality indicators, and overall surgical usefulness of AR have been assessed.
RESULTS
AR display has been used in 44.4% of resection time. Predominant AR type was navigation view (75.7%), followed by target volumes (20.1%). Predominant AR mode was picture-in-picture (PiP) (72.5%), followed by 23.3% overlay display. In 43.6% of cases, vision of important anatomical structures has been partially or entirely blocked by AR information. A total of 7.7% of cases used MRI navigation only, 30.8% used one, 23.1% used two, and 38.5% used three or more object segmentations in AR navigation. A total of 66.7% of surgeons found AR visualization helpful in the individual surgical case. AR depth information and accuracy have been rated acceptable (median 3.0 vs. median 5.0 in conventional neuronavigation). The mean utilization of the navigation pointer was 2.6 × /resection hour (AR) vs. 9.7 × /resection hour (neuronavigation); navigation effort was significantly reduced in AR (P < 0.001).
CONCLUSIONS
The main benefit of HUD-based AR visualization in brain tumor surgery is the integrated continuous display allowing for pointer-less navigation. Navigation view (PiP) provides the highest usability while blocking the operative field less frequently. Visualization quality will benefit from improvements in registration accuracy and depth impression.
GERMAN CLINICAL TRIALS REGISTRATION NUMBER
DRKS00016955.
Identifiants
pubmed: 34904183
doi: 10.1007/s00701-021-05045-1
pii: 10.1007/s00701-021-05045-1
pmc: PMC8761141
doi:
Banques de données
DRKS
['DRKS00016955']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3-14Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021. The Author(s).
Références
Asano K, Katayama K, Kakuta K, Oyama K, Ohkuma H (2017) Assessment of the accuracy and errors of head-up display by an optical neuronavigation system in brain tumor surgery. Oper Neurosurg (Hagerstown) 13(1):23–35
Cabrilo I, Bijlenga P, Schaller K (2014) Augmented reality in the surgery of cerebral aneurysms: a technical report. Neurosurgery 10 Suppl 2:252–260; discussion 260–261
Cabrilo I, Bijlenga P, Schaller K (2014) Augmented reality in the surgery of cerebral arteriovenous malformations: technique assessment and considerations. Acta Neurochir (Wien) 156(9):1769–1774
Cabrilo I, Schaller K, Bijlenga P (2015) Augmented reality-assisted bypass surgery: embracing minimal invasiveness. World Neurosurg 83(4):596–602
pubmed: 25527874
Cabrilo I, Sarrafzadeh A, Bijlenga P, Landis BN, Schaller K (2014) Augmented reality-assisted skull base surgery. Neurochirurgie 60(6):304–306
pubmed: 25245926
Carl B, Bopp M, Benescu A, Saß B, Nimsky C (2020) Indocyanine green angiography visualized by augmented reality in aneurysm surgery. World Neurosurg 142:e307–e315
pubmed: 32640326
Carl B, Bopp M, Saß B, Pojskic M, Voellger B, Nimsky C (2020) Spine surgery supported by augmented reality. Global Spine J 10(2 Suppl):41S-55S
pubmed: 32528805
pmcid: 7263340
Cho J, Rahimpour S, Cutler A, Goodwin CR, Lad SP, Codd P (2020) Enhancing reality: a systematic review of augmented reality in neuronavigation and education. World Neurosurg 139:186–195
pubmed: 32311561
Contreras López WO, Navarro PA, Crispin S (2018) Intraoperative clinical application of augmented reality in neurosurgery: a systematic review. Clin Neurol Neurosurg 177:6–11
pubmed: 30579049
Besharati Tabrizi L, Mahvash M (2015) Augmented reality-guided neurosurgery: accuracy and intraoperative application of an image projection technique. J Neurosurg 123(1):206–211
pubmed: 25748303
Deng W, Li F, Wang M, Song Z (2014) Easy-to-use augmented reality neuronavigation using a wireless tablet PC. Stereotact Funct Neurosurg 92(1):17–24
pubmed: 24216673
Dixon BJ, Daly MJ, Chan HHL, Vescan A, Witterick IJ, Irish JC (2014) Inattentional blindness increased with augmented reality surgical navigation. Am J Rhinol Allergy 28(5):433–437
pubmed: 25198032
Drouin S, Kersten-Oertel M, Louis Collins D (2015) Interaction-based registration correction for improved augmented reality overlay in neurosurgery. In: Linte CA, Yaniv Z, Fallavollita P (eds) Augmented environments for computer-assisted interventions. Springer International Publishing, Cham, pp 21–29
Edwards PJ, Hawkes DJ, Hill DL, Jewell D, Spink R, Strong A, Gleeson M (1995) Augmentation of reality using an operating microscope for otolaryngology and neurosurgical guidance. J Image Guid Surg 1(3):172–178
pubmed: 9079443
Edwards PJ, King AP, Hawkes DJ et al (1999) Stereo augmented reality in the surgical microscope. Stud Health Technol Inform 62:102–108
pubmed: 10538337
Guha D, Alotaibi NM, Nguyen N, Gupta S, McFaul C, Yang VXD (2017) Augmented reality in neurosurgery: a review of current concepts and emerging applications. Can J Neurol Sci 44(3):235–245
pubmed: 28434425
Gumprecht HK, Widenka DC, Lumenta CB (1999) BrainLab VectorVision Neuronavigation system: technology and clinical experiences in 131 cases. Neurosurgery 44(1):97–104; discussion 104–105
Grimson WL, Ettinger GJ, White SJ, Lozano-Perez T, Wells WM, Kikinis R (1996) An automatic registration method for frameless stereotaxy, image guided surgery, and enhanced reality visualization. IEEE Trans Med Imaging 15(2):129–140
pubmed: 18215896
Holloway RL (1997) Registration error analysis for augmented reality. Presence Teleoperators and Virtual Environments 6(4):413–432
Inoue D, Cho B, Mori M et al (2013) Preliminary study on the clinical application of augmented reality neuronavigation. J Neurol Surg A Cent Eur Neurosurg 74(2):71–76
pubmed: 23404553
Kalkofen D, Sandor C, White S, Schmalstieg D (2011) Visualization techniques for augmented reality. In: Furht B (ed) Handbook of Augmented Reality. Springer, New York, New York, NY, pp 65–98
Kantelhardt SR, Gutenberg A, Neulen A, Keric N, Renovanz M, Giese A (2015) Video-assisted navigation for adjustment of image-guidance accuracy to slight brain shift. Oper Neurosurg (Hagerstown) 11(4):504–511
Kato A, Yoshimine T, Hayakawa T, Tomita Y, Ikeda T, Mitomo M, Harada K, Mogami H (1991) A frameless, armless navigational system for computer-assisted neurosurgery. Technical note J Neurosurg 74(5):845–849
pubmed: 2013785
Kersten-Oertel M, Gerard I, Drouin S, Mok K, Sirhan D, Sinclair DS, Collins DL (2015) Augmented reality in neurovascular surgery: feasibility and first uses in the operating room. Int J Comput Assist Radiol Surg 10(11):1823–1836
pubmed: 25712917
Kersten-Oertel M, Jannin P, Collins DL (2013) The state of the art of visualization in mixed reality image guided surgery. Comput Med Imaging Graph 37(2):98–112
pubmed: 23490236
King AP, Edwards PJ, Maurer CR et al (2000) Stereo augmented reality in the surgical microscope. Presence: Teleoperators and Virtual Environments 9(4):360–368
Kockro RA, Tsai YT, Ng I, Hwang P, Zhu C, Agusanto K, Hong LX, Serra L (2009) Dex-ray: augmented reality neurosurgical navigation with a handheld video probe. Neurosurgery 65(4):795–808
pubmed: 19834386
Kosterhon M, Gutenberg A, Kantelhardt SR, Archavlis E, Giese A (2017) Navigation and image injection for control of bone removal and osteotomy planes in spine surgery. Oper Neurosurg (Hagerstown) 13(2):297–304
Lee C, Wong GKC (2019) Virtual reality and augmented reality in the management of intracranial tumors: a review. J Clin Neurosci. https://doi.org/10.1016/j.jocn.2018.12.036
doi: 10.1016/j.jocn.2018.12.036
pubmed: 31892496
pmcid: 6717542
Léger É, Drouin S, Collins DL, Popa T, Kersten-Oertel M (2017) Quantifying attention shifts in augmented reality image-guided neurosurgery. Healthc Technol Lett 4(5):188–192
pubmed: 29184663
pmcid: 5683248
Liu T, Tai Y, Zhao C, Wei L, Zhang J, Pan J, Shi J (2020) Augmented reality in neurosurgical navigation: a survey. Int J Med Robot e2160
Maciunas RJ, Berger MS, Copeland B, Mayberg MR, Selker R, Allen GS (1996) A technique for interactive image-guided neurosurgical intervention in primary brain tumors. Neurosurg Clin N Am 7(2):245–266
pubmed: 8726439
Mascitelli JR, Schlachter L, Chartrain AG, Oemke H, Gilligan J, Costa AB, Shrivastava RK, Bederson JB (2018) Navigation-linked heads-up display in intracranial surgery: early experience. Oper Neurosurg (Hagerstown) 15(2):184–193
Maurer CR Jr, Sauer F, Hu B et al (2001) Augmented-reality visualization of brain structures with stereo and kinetic depth cues: system description and initial evaluation with head phantom. Proceedings of SPIE Medical Imaging 2001:445–456
Meola A, Cutolo F, Carbone M, Cagnazzo F, Ferrari M, Ferrari V (2017) Augmented reality in neurosurgery: a systematic review. Neurosurg Rev 40(4):537–548
pubmed: 27154018
Mikhail M, Mithani K, Ibrahim GM (2019) Presurgical and intraoperative augmented reality in neuro-oncologic surgery: clinical experiences and limitations. World Neurosurg 128:268–276
pubmed: 31103764
Milgram P, Kishino F (1994) A taxonomy of mixed reality visual displays. Ieice T Inf Syst E77d:1321–1329
Perwög M, Bardosi Z, Diakov G, Jeleff O, Kral F, Freysinger W (2018) Probe versus microscope: a comparison of different methods for image-to-patient registration. Int J CARS 13(10):1539–1548
Roberts DW, Strohbehn JW, Hatch JF, Murray W, Kettenberger H (1986) A frameless stereotaxic integration of computerized tomographic imaging and the operating microscope. J Neurosurg 65(4):545–549
pubmed: 3531430
Roessler K, Ungersboeck K, Aichholzer M, Dietrich W, Goerzer H, Matula C, Czech T, Koos WT (1998) Frameless stereotactic lesion contour-guided surgery using a computer-navigated microscope. Surg Neurol 49(3):282–288 (discussion 288-289)
pubmed: 9508116
Rychen J, Goldberg J, Raabe A, Bervini D (2020) Augmented reality in superficial temporal artery to middle cerebral artery bypass surgery: technical note. Oper Neurosurg (Hagerstown) 18(4):444–450
Sielhorst T, Feuerstein M, Navab N (2008) Advanced medical displays: a literature review of augmented reality. Journal of Display Technology 4(4):451–467
Spetzger U, Laborde G, Gilsbach JM (1995) Frameless neuronavigation in modern neurosurgery. Minim Invasive Neurosurg 38(4):163–166
pubmed: 8750659
Toyooka T, Otani N, Wada K, Tomiyama A, Takeuchi S, Fujii K, Kumagai K, Fujii T, Mori K (2018) Head-up display may facilitate safe keyhole surgery for cerebral aneurysm clipping. J Neurosurg 129(4):883–889
pubmed: 29192858
Watanabe E, Watanabe T, Manaka S, Mayanagi Y, Takakura K (1987) Three-dimensional digitizer (neuronavigator): new equipment for computed tomography-guided stereotaxic surgery. Surg Neurol 27(6):543–547
pubmed: 3554569