Indocyanine Green Angiography Visualized by Augmented Reality in Aneurysm Surgery

Area of Science:

• Neurosurgery
• Medical Imaging
• Augmented Reality

Background:

• Aneurysm surgery requires precise visualization of complex vascular structures.
• Current methods for intraoperative imaging can be distracting and limit surgical maneuverability.

Purpose of the Study:

• To integrate indocyanine green (ICG) angiography with augmented reality (AR) for enhanced visualization during aneurysm surgery.
• To evaluate the feasibility and benefits of AR-guided ICG angiography in a clinical setting.

Main Methods:

• Prospective investigation in 20 patients with 22 aneurysms using an operating microscope with a head-up display for AR.
• Indocyanine green angiography (ICG-AR) was superimposed as a live video overlay.
• Three-dimensional (3D) vessel architecture was visualized using AR with intraoperative low-dose computed tomography (vessel-AR).

Main Results:

• Successful implementation of both ICG-AR and vessel-AR in all patients.
• ICG-AR allowed direct observation of vessel flow in white light, facilitating surgical manipulation.
• Vessel-AR improved 3D anatomical understanding with high accuracy (target registration error: 0.71 ± 0.21 mm).

Conclusions:

• ICG-AR integration is feasible and beneficial for aneurysm surgery.
• Direct visualization of ICG flow and AR-enhanced 3D anatomy improve surgical precision and understanding.
• This technology enhances intraoperative decision-making and reduces reliance on separate imaging screens.