Augmented reality for external ventricular drain placement: Model alignment and integration software

External ventricular drainage (EVD) is a critical neurosurgical procedure for managing conditions. Despite its widespread use, EVD placement is associated with specific risks, as improper catheter positioning can lead to severe complications. Recent advancements in augmented reality (AR) technology present new opportunities to improve the precision and safety of surgical interventions.

This study presents a new AR-assisted approach for EVD placement, utilizing the Microsoft HoloLens 2 and the Medgital software. We conducted a clinical trial involving three patients requiring EVD due to acute hydrocephalus or subarachnoid hemorrhage. The study adhered to ethical standards and was approved by an Ethics Committee, with informed consent obtained from all participants. Two alignment methods were employed: cranial landmark-based and QR code-based alignment. Preoperative imaging facilitated the creation of patient-specific 3D models, which were aligned with the patient's anatomy during surgery.

The results suggest that AR navigation may improve the accuracy of catheter placement. In the first case, EVD was placed with a deviation of 2.3 mm from the planned trajectory, while the second and third cases achieved deviations of 1.5 mm and 0.5 mm, respectively. These results indicate the potential effectiveness of the AR system. Importantly, no postoperative complications were observed, suggesting the safety of the AR-guided approach.

This study suggests the viability of AR-assisted navigation in neurosurgical practice, particularly for EVD placement. The promising results support further exploration and integration of AR technologies in surgical settings, aiming to improve patient outcomes and procedural efficiency in neurosurgery.