Augmented reality in transsphenoidal surgery.

Augmented reality in transsphenoidal surgery.

World Neurosurg. 2019 Feb 11;:

Authors: Carl B, Bopp M, Voellger B, Saß B, Nimsky C

Abstract
OBJECTIVE: To investigate how augmented reality (AR) can be applied to support transsphenoidal surgery.
METHODS: AR was established using the head-up displays integrated into operating microscopes. Navigation registration was performed either fiducial-based or by automatic registration applying intraoperative computed tomography (iCT). Correct microscope calibration was ensured by checking the geometric overlap between the AR representation of the reference array and 3-D reality while focusing on the reference array.
RESULTS: Out of a consecutive single surgeon series of 288 transsphenoidal procedures, 47 patients (16.3%) underwent microscope-based AR to visualize target and risk structures. AR was smoothly integrated into the surgical workflow. AR accuracy depended on navigation accuracy, as well as microscope calibration. The target registration error (TRE) in patients with fiducial-based registration was 2.33 ± 1.30 mm. Automatic, user-independent iCT-based registration significantly (p < 0.001) increased AR accuracy (TRE: 0.83 ± 0.44 mm). Applying low-dose iCT protocols reduced the effective dose caused by iCT registration scanning to the range of a single chest x-ray examination (0.041 mSv). No vascular injuries, as well as no aggravation of neurological deficits occurred in this series. AR greatly facilitated orientation in the reoperations and in patients with anatomical variants, thereby increasing surgeon comfort. Enhanced AR visualizations improved 3-D perception compared to the standard display of dashed lines by the HUD of the operating microscope.
CONCLUSIONS: Microscope-based AR is a reliable tool to increase patient safety in complicated transsphenoidal procedures. Intraoperative imaging-based automatic patient registration is recommended.

PMID: 30763743 [PubMed - as supplied by publisher]

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