Related Experiment Video
Updated: Oct 28, 2026
Pioneering Patient-Specific Approaches for Precision Surgery Using Imaging and Virtual Reality
Published on: April 5, 2024
Head-Mounted Augmented Reality in the Planning of Cerebral Cavernous Malformation Resections: Demonstrating
Luke L Jouppi1,2, Clifford A Pierre1,3, Matias Luis Costa1,3,4
1Seattle Science Foundation, Seattle, WA 98122, USA.
Objectives:
Lesion localization, associated vascular structures, and corticotomy selection pose key challenges when planning cerebral cavernous malformation (CCM) resections in eloquent areas. Head-mounted augmented reality (HMAR) may improve visualization without the gaze disruptions imposed by conventional neuronavigation. This study investigated the preoperative feasibility of HMAR in surgical plan modifications and educational value.
Methods:
We performed a single-center retrospective review of all CCM patients with HMAR-assisted preoperative planning from 1 September, 2022, to 31 August, 2024. Three-dimensional reconstructions of patients' magnetic resonance imaging were viewed preoperatively using HMAR. Registration accuracy was confirmed against conventional neuronavigation. Surgical plan modifications entailed alterations of the operative goal, trajectory, or steps. Educational value of HMAR was appraised by trainees as "not helpful" when only confirming existing plans, "helpful" when facilitating a greater understanding of the lesion, and "very helpful" when spurring additional positioning or plan modifications.
Results:
Of 19 patients with CCM resections, 14 patients with HMAR-assisted preoperative planning were included. The average age was 38.6 ± 14.5 years, with 6 males and 8 females. Three of 14 (21%) surgical approaches were modified following HMAR use: two to minimize cortical disruption and one to avoid injuring an associated developmental venous anomaly. Registration was accurate in all cases. Between registration and utilization, HMAR added an average of 2.7 ± 1.0 min in the operating room. The mean appraisal of the educational value of HMAR was "helpful."
Conclusions:
Preoperative planning with HMAR prompted surgical plan modifications and often improved trainees' understanding without introducing significant workflow disruptions. Three-dimensional visualization offered dynamic spatial details beyond traditional two-dimensional multiplanar MRI.
