From planning to execution: Interactive virtual-reality assisted craniotomy planning in meningioma surgery

In meningioma surgery, extent and accuracy of the craniotomy are vital to achieve the predefined extent of resection. We routinely integrate interactive virtual-reality (iVR) assistance into craniotomy planning.

Are preoperatively iVR-planned approaches transferable to craniotomies subsequently performed in the operating room?

We examined 83 patients surgically treated with meningiomas, where the approach strategy was preoperatively planned and demonstrated using the MagicLeap 2 or HoloLens 2. The iVR-planned approach (iVR-Group) was compared to the real craniotomy (Real-Group) by location and relative size of craniotomy, as well as position and number of burr holes.

When comparing the craniotomy size, the mean anterior-posterior (AP)-ratio was 0.40 in iVR-group vs 0.41 in Real-group with 17.5% mean deviation, while the mean lateral ratio was 0.45 vs 0.49 with 15.9% mean deviation.In 9.6% of procedures, a diverging number of burr holes were used, in 3.6% the position was altered from iVR-group to Real-group. In testing for equality (TOST-test) both AP and lateral-ratio deviation showed significant results: AP-ratio-deviation: p = 0.015, CI: -0.047-0.013, equivalence margin ±0.059; lateral ratio-deviation p = 0.041, CI: -0.068-0.004, equivalence margin ±0.071. The geometrical index was 0.423 for iVR group and 0.448 for Real-group. The percentage deviation between both groups was 5.9%, indicating high transferability of preoperative planning.

With state-of-the-art iVR-planning of meningioma surgery approaches, craniotomies respecting pathological and anatomical relations and conflicts can be accurately simulated. IVR planning may mark a new level of interactive learning and strategic planning in neurosurgery.