Abstract
BackgroundPrecise location of intracranial lesions before surgery is important, but occasionally difficult. Modern navigation systems are very helpful, but expensive. A low-cost solution that could locate brain lesions and their surface projections in augmented reality would be beneficial. We used an iPhone to partially achieve this goal, and evaluated its accuracy and feasibility in a clinical neurosurgery setting.Methodology/Principal FindingsWe located brain lesions in 35 patients, and using an iPhone, we depicted the lesion’s surface projection onto the skin of the head. To assess the accuracy of this method, we pasted computed tomography (CT) markers surrounding the depicted lesion boundaries on the skin onto 15 patients. CT scans were then performed with or without contrast enhancement. The deviations (D) between the CT markers and the actual lesion boundaries were measured. We found that 97.7% of the markers displayed a high accuracy level (D ≤ 5mm). In the remaining 20 patients, we compared our iPhone-based method with a frameless neuronavigation system. Four check points were chosen on the skin surrounding the depicted lesion boundaries, to assess the deviations between the two methods. The integrated offset was calculated according to the deviations at the four check points. We found that for the supratentorial lesions, the medial offset between these two methods was 2.90 mm and the maximum offset was 4.2 mm.Conclusions/SignificanceThis low-cost, image-based, iPhone-assisted, augmented reality solution is technically feasible, and helpful for the localization of some intracranial lesions, especially shallow supratentorial intracranial lesions of moderate size.
Highlights
Precise localization of intracranial lesions before surgery is very important
Because the head is a complex three-dimensional (3D) structure that lacks surface anatomical landmarks, precise localization of an intracranial lesion and its surface projection according to two-dimensional (2D) magnetic resonance (MR) images is always difficult, especially when the lesion is small [1]
When these systems are interfaced with surgical microscopes equipped with projection systems, they can depict surface projections of brain lesions in augmented reality (AR) [4, 5]
Summary
Precise localization of intracranial lesions before surgery is very important. This information is required for surgeons to select an appropriate surgical approach, to position the patient, and to tailor the incisions. Modern neuro-navigation systems are very helpful because they provide real-time feedback in three imaging planes and 3D models of the brain [2, 3]. Both of the original images coexist as a single image, to enable visualization of the internal structures underneath the overlying tissues, providing a transparent view of the surgical anatomy Using this approach, the surgical plan can be intuitively and precisely determined [2, 3]. A lowcost technique able to locate brain lesions and their surface projections in AR before surgery, and capable of using standard diagnostic MR images, would be beneficial, especially if the requirement for highly sophisticated and expensive navigation systems could be avoided. We used an iPhone to partially achieve this goal, and evaluated its accuracy and feasibility in a clinical neurosurgery setting
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