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External Ventricular Drain Placement Using Active Augmented Reality Guidance: A Proof of Concept of a Clinically Integrable System

  • 0Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Operative Neurosurgery (hagerstown, MD.) +

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July 10, 2025

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July 10, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

A new augmented reality system for external ventricular drain (EVD) placement shows promise in improving accuracy and safety. This technology offers a feasible approach to enhance neurosurgical procedures, though further refinement is needed for clinical use.

Area Of Science

  • Neurosurgery
  • Medical Technology
  • Image-guided Therapy

Background

  • Suboptimal placement occurs in 26% of freehand external ventricular drain (EVD) procedures.
  • Traditional methods lack accuracy and safety in EVD placement.
  • A novel, low-cost augmented reality (AR) stereotactic navigation system was developed.

Purpose Of The Study

  • To evaluate the accuracy and safety of a new AR stereotactic navigation system for EVD placement.
  • To assess the system's compatibility with existing Picture Archiving and Communication Systems (PACS) and image segmentation algorithms.
  • To demonstrate the clinical and technical feasibility of an end-to-end 3D AR system for neurosurgical navigation.

Main Methods

  • The AR system integrates cloud storage, image segmentation, trajectory planning, and real-time 3D guidance.
  • Fifteen neurosurgical professionals performed 29 EVD placements on anatomical phantoms using landmark-based registration.
  • Postoperative CT scans assessed placement accuracy using the Kakarla scale, distance to target, and angular deviation.

Main Results

  • 69% of EVD placements were graded as optimal (Kakarla 1).
  • Mean distance to target was 9.49 mm, and mean angular deviation was 9.20°.
  • Fiducial registration error was 4.00 mm; workflow time averaged 22 minutes 45 seconds. Human-computer interaction challenges were noted.

Conclusions

  • The AR system demonstrates clinical and technical feasibility for enhancing EVD placement safety and accuracy.
  • Further refinement of accuracy, user interface, and procedural time is necessary for clinical implementation.
  • This proof-of-concept study highlights the potential of 3D AR navigation in neurosurgery.

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