Augmented reality head-mounted display-based incision planning in cranial neurosurgery: a prospective pilot study

Area of Science:

• Neurosurgery
• Medical Technology
• Surgical Navigation

Background:

• Monitor and wand-based neuronavigation stations (MWBNSs) are standard in cranial neurosurgery but are cumbersome, requiring OR rearrangement and interrupting surgical workflow.
• Current MWBNSs necessitate surgeons using a hand to manipulate a wand and pausing to check a remote monitor, hindering bimanual techniques and real-time guidance.
• There is a need for continuous, real-time, hands-free neuronavigation solutions to improve surgical efficiency and workflow.

Purpose of the Study:

• To investigate the feasibility of using augmented reality (AR) with a head-mounted display for mapping brain tumor borders.
• To compare the accuracy and correspondence of AR-based tumor border tracing with traditional MWBNS tracing.
• To assess AR's potential to streamline intraoperative neuronavigation in cranial neurosurgery.

Main Methods:

• A prospective pilot study involving 11 patients undergoing elective craniotomy for tumor resection.
• Surgeons used the OpenSight application on HoloLens AR glasses for tumor border tracing prior to incision.
• Tumor border tracings were compared to those obtained using the StealthStation S8 MWBNS, with blinded neurosurgeons rating correspondence and objective overlap measurements calculated.

Main Results:

• AR tracing was successfully implemented in all 11 patient procedures.
• Neurosurgeons rated the correspondence between AR and MWBNS tracings: 5 excellent, 5 adequate, and 1 poor.
• High inter-rater agreement was observed in the subjective correspondence ratings.

Conclusions:

• Augmented reality (AR) is a feasible technology for intraoperative neuronavigation and preoperative tumor border identification in neurosurgery.
• AR can be integrated into the surgical workflow, offering a hands-free alternative to traditional navigation systems.
• Further research is required to optimize AR accuracy and explore its full potential in neurosurgical applications.