Augmented reality for the virtual dissection of white matter pathways

Sebastian Ille,Evy Visch-Brink,Erik Robert,Pierre Robe,Sandro M Krieg,Henry Colle,Catarina Pessanha Viegas,Djaina Satoer,Martine Van Zandvoort,John Goodden,David Colle,Emmanuel Mandonnet,Olga Dragoy,Ann-Katrin Ohlerth,Adrià Rofes

doi:10.1007/s00701-020-04545-w

Abstract

BackgroundThe human white matter pathway network is complex and of critical importance for functionality. Thus, learning and understanding white matter tract anatomy is important for the training of neuroscientists and neurosurgeons. The study aims to test and evaluate a new method for fiber dissection using augmented reality (AR) in a group which is experienced in cadaver white matter dissection courses and in vivo tractography.MethodsFifteen neurosurgeons, neurolinguists, and neuroscientists participated in this questionnaire-based study. We presented five cases of patients with left-sided perisylvian gliomas who underwent awake craniotomy. Diffusion tensor imaging fiber tracking (DTI FT) was performed and the language-related networks were visualized separated in different tracts by color. Participants were able to virtually dissect the prepared DTI FTs using a spatial computer and AR goggles. The application was evaluated through a questionnaire with answers from 0 (minimum) to 10 (maximum).ResultsParticipants rated the overall experience of AR fiber dissection with a median of 8 points (mean ± standard deviation 8.5 ± 1.4). Usefulness for fiber dissection courses and education in general was rated with 8 (8.3 ± 1.4) and 8 (8.1 ± 1.5) points, respectively. Educational value was expected to be high for several target audiences (student: median 9, 8.6 ± 1.4; resident: 9, 8.5 ± 1.8; surgeon: 9, 8.2 ± 2.4; scientist: 8.5, 8.0 ± 2.4). Even clinical application of AR fiber dissection was expected to be of value with a median of 7 points (7.0 ± 2.5).ConclusionThe present evaluation of this first application of AR for fiber dissection shows a throughout positive evaluation for educational purposes.

Highlights

MethodsAs we have learned from surgical and neuroscientific studies, knowledge of white matter anatomy is crucial for the surgical treatment of eloquent gliomas [3, 9, 14]
The present evaluation of this first application of augmented reality (AR) for fiber dissection shows a throughout positive evaluation for educational purposes
Our current knowledge of this complex anatomy is currently based on cadaver dissections, insights through direct electrical stimulation (DES) during awake craniotomy surgery, and white matter tractography on MRI, for example by diffusion tensor imaging fiber tracking (DTI FT) [1, 4, 5, 7, 10, 13, 15]

Summary

Introduction

MethodsAs we have learned from surgical and neuroscientific studies, knowledge of white matter anatomy is crucial for the surgical treatment of eloquent gliomas [3, 9, 14]. Our current knowledge of this complex anatomy is currently based on cadaver dissections, insights through direct electrical stimulation (DES) during awake craniotomy surgery, and white matter tractography on MRI, for example by diffusion tensor imaging fiber tracking (DTI FT) [1, 4, 5, 7, 10, 13, 15]. Learning and understanding white matter pathway anatomy is an important part of the training for neuroscientists and physicians. This is the motivation behind the growing number of white matter dissection courses being developed worldwide. Even clinical application of AR fiber dissection was expected to be of value with a median of 7 points (7.0 ± 2.5)

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