Department of Neurosurgery, University of Marburg, Marburg, Germany.
Department of Neurosurgery, University of Marburg, Marburg, Germany; Marburg Center for Mind, Brain, and Behavior, Marburg, Germany.
World Neurosurg. 2019 May;125:e873-e883. doi: 10.1016/j.wneu.2019.01.202. Epub 2019 Feb 11.
We investigated how augmented reality (AR) can be applied to support transsphenoidal surgery.
AR was established using the head-up displays integrated into operating microscopes. Navigation registration was performed with either fiducial-based or automatic registration using intraoperative computed tomography (iCT). Correct microscope calibration was ensured by checking the geometric overlap between the AR representation of the reference array and the 3-dimensional reality while focusing on the reference array.
From a consecutive single-surgeon series of 288 transsphenoidal procedures, 47 patients (16.3%) had undergone microscope-based AR to visualize the target and risk structures. AR was smoothly integrated into the surgical workflow. AR accuracy depended on navigation accuracy and microscope calibration. The target registration error in patients with fiducial-based registration was 2.33 ± 1.30 mm. Automatic, user-independent iCT-based registration significantly (P < 0.001) increased AR accuracy (target registration error, 0.83 ± 0.44 mm). Applying low-dose iCT protocols reduced the effective dose caused by iCT registration scanning to within the range of a single chest radiograph (0.041 mSv). No vascular injuries and no aggravation of neurological deficits occurred in the present series. AR greatly facilitated orientation in the reoperations and the patients with anatomical variants, thereby increasing surgeon comfort. Enhanced AR visualizations improved the 3-dimensional perception compared with the standard display of dashed lines by the head-up display of the operating microscope.
Microscope-based AR is a reliable tool to increase patient safety in complicated transsphenoidal procedures. Intraoperative imaging-based automatic patient registration is recommended.
研究增强现实（AR）技术如何应用于经蝶窦手术以提供支持。
通过集成到手术显微镜中的头戴式显示器建立 AR，使用基于基准点或自动配准的方式进行导航注册，使用术中计算机断层扫描（iCT）。通过在关注基准点的同时检查 AR 参考阵列表示与 3 维现实之间的几何重叠，来确保显微镜的正确校准。
在连续的单外科医生系列 288 例经蝶窦手术中，有 47 例（16.3%）患者接受了基于显微镜的 AR 以可视化目标和风险结构。AR 顺利地集成到手术流程中。AR 准确性取决于导航准确性和显微镜校准。基于基准点的注册患者的目标注册误差为 2.33±1.30mm。自动、用户独立的基于 iCT 的注册显著（P<0.001）提高了 AR 准确性（目标注册误差，0.83±0.44mm）。应用低剂量 iCT 方案将 iCT 注册扫描引起的有效剂量降低到单次胸部 X 线摄影范围内（0.041mSv）。本系列中未发生血管损伤或神经功能缺损恶化。AR 极大地促进了再手术和解剖变异患者的定向，从而提高了外科医生的舒适度。增强的 AR 可视化与手术显微镜头戴式显示器的虚线标准显示相比，改善了 3 维感知。
基于显微镜的 AR 是增加复杂经蝶窦手术患者安全性的可靠工具。建议使用基于术中成像的自动患者配准。
