244 The Inaugural “Century” of Mixed Reality in Cranial Surgery: Virtual Reality Rehearsal/Augmented Reality Guidance and Its Learning Curve in the First Single-Surgeon, 100-Case Series

Abstract

INTRODUCTION: Virtual reality (VR) and augmented reality (AR), together called Mixed reality (MxR) gaining importance in Neurosurgery as it helps to select apporaches and identify key anatomic landmarks intraoperatively. METHODS: The first 100 consecutive cases of a single surgeon for which MxR was intended for use were retrospectivaly analyzed for specific contributions to the opeation. Seventeen cases in the study cohort were matched with historical non-MxR cases for comparison of outcome parameters. The cases in which MxR failed were plotted over time to determine the nature of the “learning curve.” RESULTS: The nadir of the blue line is at case 44. The inflection point of the trend line (black) occurred at approximately case 63.This provides some evidence of proficiency acquisition in between. MxR helped to limit the size of the opening in 44 cases, enhanced precise placement of the craniotomy in 64 cases, increased the guidance efficiency to target or marker in 58 cases, and protected anti-targets from surgical incursion in 12 cases. Cases where MxR had above-expectation performances will be highlighted. Comparing MxR cases with matching non-MxR, the average EBL (106.8 mL vs. 142.4 mL), LOS (5.4 d vs. 8.2 d) and surgery duration (218.4 mins. 252.8 min) were all smaller for the MxR group. However, no statistically significant differences were found for all three comparisons. CONCLUSIONS: MxR enhances surgical planning and can supplant probe-and-monitor navigation for efficient intraoperative guidance without additional time for surgery or hospitalization