High-Accuracy Augmented Reality Guidance for Intracranial Drain Placement Using a Standalone Head-Worn Navigation...

Area of Science:

• Neurosurgery
• Medical Technology
• Image Guidance

Background:

• Freehand external ventricular drain (EVD) placement has suboptimal accuracy (70%).
• Existing image-guided methods are often impractical.
• There is a need for improved EVD placement techniques.

Purpose of the Study:

• To evaluate the feasibility, safety, and clinical performance of high-accuracy augmented reality (AR) guidance for EVD placement.
• To address the limitations of freehand and current image-guided EVD placement.

Main Methods:

• Prospective clinical pilot study comparing AR-guided EVD placement with a freehand control group.
• Utilized a standalone AR headset with high-accuracy infrared tracking.
• Assessed placement quality using the extended modified Kakarla scale.

Main Results:

• AR-guided EVD placement achieved 100% functional placement on the first attempt versus 64% in the control group (P = .045).
• Optimal placement rates were 73% with AR versus 27% freehand (P = .043).
• AR group had no revisions and fewer complications (18% vs 45%).

Conclusions:

• High-accuracy AR guidance is a safe and effective method for EVD placement.
• AR guidance significantly improves placement quality, success rates, and reduces revisions.
• Results support initiating a multicenter randomized controlled trial for AR-guided EVD placement.