Utilization of Navigation-Integrated, Mixed Reality Templates for Minimizing Invasiveness of Neurosurgical Procedures: A Case Series

Abstract

BACKGROUND: The tenets of minimally invasive neurosurgery require small craniotomies that nevertheless afford sufficient surgical freedom to safely accomplish the operative goal. OBJECTIVE: To present a novel technique which couples surgical rehearsal in virtual reality (VR) with navigation-integrated, microscope-synchronized augmented reality (AR) to optimize minimally invasive openings. METHODS: A retrospective review of the senior author's early experience with this mixed reality (VR + AR) platform was conducted. Patient-specific VR models were rendered from standard computed tomography/MRI. Surgical rehearsal with these models created templates with the optimal opening, which were integrated with the AR system. In surgery, the templates were projected through a navigation-tracked microscope and appeared as AR objects onto the patient. The templates guided the planning of the incision and steps of the approach. RESULTS: Sixteen patients were included in this study, 11 women and 5 men (33-79 years; median: 59.5). Twelve operations were performed for mass lesions and 4 for microvascular decompression for trigeminal neuralgia. There were no intraoperative adverse events related to AR. For 15 patients (94%), the templates provided major advantage in optimizing the bony opening and guided the operation to the specific anatomic location chosen preoperatively. For 1 patient, the AR template guided the drilling away from the critical structures inside the temporal bone. In addition, 3-dimensional AR markers relieve the surgeon from ergonomically cumbersome monitor-based navigation (Video 1). CONCLUSION: This novel mixed reality platform combines surgical rehearsal in VR and navigation-integrated, microscope-synchronized overlay of AR templates to ensure that optimal exposure is efficiently obtained.