Neurosurg Focus. 2021 Aug;51(2):E20. doi: 10.3171/2021.5.FOCUS21206.
OBJECTIVE: The aim of this study was to assess the precision and feasibility of 3D-printed marker-based augmented reality (AR) neurosurgical navigation and its use intraoperatively compared with optical tracking neuronavigation systems (OTNSs). METHODS: Three-dimensional-printed markers for CT and MRI and intraoperative use were applied with mobile devices using an AR light detection and ranging (LIDAR) camera. The 3D segmentations of intracranial tumors were created with CT and MR images, and preoperative registration of the marker and pathology was performed. A patient-specific, surgeon-facilitated mobile application was developed, and a mobile device camera was used for neuronavigation with high accuracy, ease, and cost-effectiveness. After accuracy values were preliminarily assessed, this technique was used intraoperatively in 8 patients. RESULTS: The mobile device LIDAR camera was found to successfully overlay images of virtual tumor segmentations according to the position of a 3D-printed marker. The targeting error that was measured ranged from 0.5 to 3.5 mm (mean 1.70 ± 1.02 mm, median 1.58 mm). The mean preoperative preparation time was 35.7 ± 5.56 minutes, which is longer than that for routine OTNSs, but the amount of time required for preoperative registration and the placement of the intraoperative marker was very brief compared with other neurosurgical navigation systems (mean 1.02 ± 0.3 minutes). CONCLUSIONS: The 3D-printed marker-based AR neuronavigation system was a clinically feasible, highly precise, low-cost, and easy-to-use navigation technique. Three-dimensional segmentation of intracranial tumors was targeted on the brain and was clearly visualized from the skin incision to the end of surgery.
目的:本研究旨在评估基于 3D 打印标记的增强现实(AR)神经外科导航的精度和可行性,并与光学跟踪神经导航系统(OTNS)比较其在术中的使用情况。
方法:使用移动设备上的 AR 激光检测和测距(LIDAR)相机,应用适用于 CT 和 MRI 的 3D 打印标记物和术中使用。通过 CT 和 MRI 图像创建颅内肿瘤的 3D 分割,并对标记物和病理学进行术前注册。开发了一种基于患者和外科医生的移动应用程序,移动设备的摄像头可用于高精度、简便且具有成本效益的神经导航。在初步评估了准确性值后,该技术在 8 名患者中得到了术中应用。
结果:移动设备的 LIDAR 相机成功地根据 3D 打印标记的位置叠加了虚拟肿瘤分割的图像。测量的靶向误差范围为 0.5 至 3.5 毫米(平均 1.70±1.02 毫米,中位数 1.58 毫米)。术前准备的平均时间为 35.7±5.56 分钟,虽然比常规 OTNS 长,但与其他神经外科导航系统相比,术前注册和术中标记物放置所需的时间非常短暂(平均 1.02±0.3 分钟)。
结论:基于 3D 打印标记的 AR 神经导航系统是一种具有临床可行性、高精度、低成本和易于使用的导航技术。颅内肿瘤的 3D 分割在大脑上进行了靶向定位,并从皮肤切口到手术结束都清晰可见。
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