Augmented Reality-Assisted Craniotomy for Parasagittal and Convexity En Plaque Meningiomas and Custom-Made Cranio-Plasty: A Preliminary Laboratory Report.

Nicola Montemurro,Fabrizio Cutolo,Vincenzo Ferrari,Nadia Cattari,Sara Condino,Renzo D’Amato

doi:10.3390/ijerph18199955

Abstract

Background: This report discusses the utility of a wearable augmented reality platform in neurosurgery for parasagittal and convexity en plaque meningiomas with bone flap removal and custom-made cranioplasty. Methods: A real patient with en plaque cranial vault meningioma with diffuse and extensive dural involvement, extracranial extension into the calvarium, and homogeneous contrast enhancement on gadolinium-enhanced T1-weighted MRI, was selected for this case study. A patient-specific manikin was designed starting with the segmentation of the patient’s preoperative MRI images to simulate a craniotomy procedure. Surgical planning was performed according to the segmented anatomy, and customized bone flaps were designed accordingly. During the surgical simulation stage, the VOSTARS head-mounted display was used to accurately display the planned craniotomy trajectory over the manikin skull. The precision of the craniotomy was assessed based on the evaluation of previously prepared custom-made bone flaps. Results: A bone flap with a radius 0.5 mm smaller than the radius of an ideal craniotomy fitted perfectly over the performed craniotomy, demonstrating an error of less than ±1 mm in the task execution. The results of this laboratory-based experiment suggest that the proposed augmented reality platform helps in simulating convexity en plaque meningioma resection and custom-made cranioplasty, as carefully planned in the preoperative phase. Conclusions: Augmented reality head-mounted displays have the potential to be a useful adjunct in tumor surgical resection, cranial vault lesion craniotomy and also skull base surgery, but more study with large series is needed.

Highlights

In recent years, there has been considerable interest in using augmented reality (AR)head-mounted displays (HMDs), either video see-through (VST) or optical see-through (OST), and mobile devices for AR in the operating room (OR) [1,2,3,4]
Using a piezoelectric saw (Piezosurgery 3 by Mectron spa, Carasco, Italy), the surgeon performed the craniotomy on the head of the manikin, and removed the bone flap with the extra-axial intradiploic lesion (Figure 8B)
The five previously prepared custom-made bone flaps were placed on the head of the manikin to select the best fitting one

Summary

Introduction

There has been considerable interest in using augmented reality (AR)head-mounted displays (HMDs), either video see-through (VST) or optical see-through (OST), and mobile devices for AR in the operating room (OR) [1,2,3,4]. Some consumerlevel and general purposes OST HMDs, such as the Microsoft®® HoloLens®® , can be successfully used for preoperative simulation, for planning and for monitoring patient’s vitals in real-time during surgical procedures. The use of HMDs for surgical resection of intracranial meningiomas, which account for 30% of all primary intracranial tumors [16], has already been. This report discusses the utility of a wearable augmented reality platform in neurosurgery for parasagittal and convexity en plaque meningiomas with bone flap removal and custom-made cranioplasty. Surgical planning was performed according to the segmented anatomy, and customized bone flaps were designed . During the surgical simulation stage, the VOSTARS head-mounted display was used to accurately display the planned craniotomy trajectory over the manikin skull. The precision of the craniotomy was assessed based on the evaluation of previously prepared custom-made bone flaps.

Objectives

Methods

Results

Discussion

Conclusion