增强现实辅助脑室造口术。

Augmented reality-assisted ventriculostomy.

机构信息

1Department of Neurosurgery, University of Ulm, Günzburg; and.

2Health Robotics and Automation Lab, Institute for Anthropomatics and Robotics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.

出版信息

Neurosurg Focus. 2021 Jan;50(1):E16. doi: 10.3171/2020.10.FOCUS20779.

DOI:10.3171/2020.10.FOCUS20779

PMID:33386016

Abstract

OBJECTIVE

Placement of a ventricular drain is one of the most common neurosurgical procedures. However, a higher rate of successful placements with this freehand procedure is desirable. The authors' objective was to develop a compact navigational augmented reality (AR)-based tool that does not require rigid patient head fixation, to support the surgeon during the operation.

METHODS

Segmentation and tracking algorithms were developed. A commercially available Microsoft HoloLens AR headset in conjunction with Vuforia marker-based tracking was used to provide guidance for ventriculostomy in a custom-made 3D-printed head model. Eleven surgeons conducted a series of tests to place a total of 110 external ventricular drains under holographic guidance. The HoloLens was the sole active component; no rigid head fixation was necessary. CT was used to obtain puncture results and quantify success rates as well as precision of the suggested setup.

RESULTS

In the proposed setup, the system worked reliably and performed well. The reported application showed an overall ventriculostomy success rate of 68.2%. The offset from the reference trajectory as displayed in the hologram was 5.2 ± 2.6 mm (mean ± standard deviation). A subgroup conducted a second series of punctures in which results and precision improved significantly. For most participants it was their first encounter with AR headset technology and the overall feedback was positive.

CONCLUSIONS

To the authors' knowledge, this is the first report on marker-based, AR-guided ventriculostomy. The results from this first application are encouraging. The authors would expect good acceptance of this compact navigation device in a supposed clinical implementation and assume a steep learning curve in the application of this technique. To achieve this translation, further development of the marker system and implementation of the new hardware generation are planned. Further testing to address visuospatial issues is needed prior to application in humans.

摘要

目的

放置脑室引流管是最常见的神经外科手术之一。然而，人们希望这种徒手操作的方法能有更高的成功率。作者的目标是开发一种紧凑的基于导航的增强现实（AR）工具，该工具不需要刚性的患者头部固定，以在手术过程中为外科医生提供支持。

方法

开发了分割和跟踪算法。使用市售的 Microsoft HoloLens AR 耳机和 Vuforia 基于标记的跟踪，为定制的 3D 打印头模型中的脑室造口术提供指导。11 名外科医生进行了一系列测试，总共在全息引导下放置了 110 个外部脑室引流管。HoloLens 是唯一的主动组件；不需要刚性头部固定。使用 CT 获得穿刺结果，并量化成功率以及建议设置的精度。

结果

在所提出的设置中，系统可靠且性能良好。所报告的应用显示总体脑室造口术成功率为 68.2%。全息图中显示的参考轨迹的偏移量为 5.2 ± 2.6 毫米（平均值 ± 标准差）。一个小组进行了第二次穿刺系列，结果和精度显著提高。对于大多数参与者来说，这是他们第一次接触 AR 耳机技术，整体反馈是积极的。

结论

据作者所知，这是第一个关于基于标记的 AR 引导脑室造口术的报告。该首次应用的结果令人鼓舞。作者预计在假设的临床实施中，这种紧凑的导航设备会得到很好的接受，并假设在应用这项技术时会有一个陡峭的学习曲线。为了实现这一翻译，计划进一步开发标记系统并实施新一代硬件。在应用于人类之前，还需要进一步测试解决视空间问题。