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Augmented Reality (AR) is increasingly used in medical applications for visualizing medical information. In this paper, we present an AR-assisted surgical guidance system that aims to improve the accuracy of catheter placement in ventriculostomy, a common neurosurgical procedure. We build upon previous work on neurosurgical AR, which has focused on enabling the surgeon to visualize a patient’s ventricular anatomy, to additionally integrate surgical tool tracking and contextual guidance. Specifically, using accurate tracking of optical markers via an external multi-camera OptiTrack system, we enable Microsoft HoloLens 2-based visualizations of ventricular anatomy, catheter placement, and the information on how far the catheter tip is from its target. We describe the system we developed, present initial hologram registration results, and comment on the next steps that will prepare our system for clinical evaluations.
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Accuracy of routine external ventricular drain placement following a mixed reality–guided twist-drill craniostomy
The traditional freehand placement of an external ventricular drain (EVD) relies on empirical craniometric landmarks to guide the craniostomy and subsequent passage of the EVD catheter. The diameter and trajectory of the craniostomy physically limit the possible trajectories that can be achieved during the passage of the catheter. In this study, the authors implemented a mixed reality–guided craniostomy procedure to evaluate the benefit of an optimally drilled craniostomy to the accurate placement of the catheter. Optical marker–based tracking using an OptiTrack system was used to register the brain ventricular hologram and drilling guidance for craniostomy using a HoloLens 2 mixed reality headset. A patient-specific 3D-printed skull phantom embedded with intracranial camera sensors was developed to automatically calculate the EVD accuracy for evaluation. User trials consisted of one blind and one mixed reality–assisted craniostomy followed by a routine, unguided EVD catheter placement for each of two different drill bit sizes. A total of 49 participants were included in the study (mean age 23.4 years, 59.2% female). The mean distance from the catheter target improved from 18.6 ± 12.5 mm to 12.7 ± 11.3 mm (p = 0.0008) using mixed reality guidance for trials with a large drill bit and from 19.3 ± 12.7 mm to 10.1 ± 8.4 mm with a small drill bit (p < 0.0001). Accuracy using mixed reality was improved using a smaller diameter drill bit compared with a larger bit (p = 0.039). Overall, the majority of the participants were positive about the helpfulness of mixed reality guidance and the overall mixed reality experience. Appropriate indications and use cases for the application of mixed reality guidance to neurosurgical procedures remain an area of active inquiry. While prior studies have demonstrated the benefit of mixed reality–guided catheter placement using predrilled craniostomies, the authors demonstrate that real-time quantitative and visual feedback of a mixed reality–guided craniostomy procedure can independently improve procedural accuracy and represents an important tool for trainee education and eventual clinical implementation.
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- PAR ID:
- 10490941
- Publisher / Repository:
- JNS
- Date Published:
- Journal Name:
- Neurosurgical Focus
- Volume:
- 56
- Issue:
- 1
- ISSN:
- 1092-0684
- Page Range / eLocation ID:
- E11
- Subject(s) / Keyword(s):
- external ventricular drainage craniostomy mixed reality augmented reality image-guided surgery HoloLens
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.3171/2023.10.FOCUS23615
