2Faculty of Medicine, University of Geneva, Geneva, Switzerland.
1Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals; and.
Neurosurg Focus. 2021 Aug;51(2):E19. doi: 10.3171/2021.5.FOCUS21202.
Intracranial minimally invasive procedures imply working in a restricted surgical corridor surrounded by critical structures, such as vessels and cranial nerves. Any damage to them may affect patient outcome. Neuronavigation systems may reduce the risk of such complications. In this study, the authors sought to compare standard neuronavigation (NV) and augmented reality (AR)-guided navigation with respect to the integrity of the perifocal structures during a neurosurgical approach using a novel model imitating intracranial vessels.
A custom-made box, containing crisscrossing hard metal wires, a hidden nail at its bottom, and a wooden top, was scanned, fused, and referenced for the purpose of the study. The metal wires and an aneurysm clip applier were connected to a controller, which counted the number of contacts between them. Twenty-three naive participants were asked to 1) use NV to define an optimal entry point on the top, perform the smallest craniotomy possible on the wooden top, and to use a surgical microscope when placing a clip on the nail without touching the metal wires; and 2) use AR to preoperatively define an ideal trajectory, navigate the surgical microscope, and then perform the same task. The primary outcome was the number of contacts made between the metal wires and the clip applier. Secondary outcomes were craniotomy size, and trust in NV and AR to help avoid touching the metal wires, as assessed by a 9-level Likert scale.
The median number of contacts tended to be lower with the use of AR than with NV (AR, median 1 [Q1: 1, Q3: 2]; NV, median 3 [Q1: 1, Q3: 6]; p = 0.074). The size of the target-oriented craniotomy was significantly lower with the use of AR compared with NV (AR, median 4.91 cm2 [Q1: 4.71 cm2, Q3: 7.55 cm2]; and NV, median 9.62 cm2 [Q1: 7.07 cm2; Q3: 13.85 cm2]). Participants had more trust in AR than in NV (the differences posttest minus pretest were mean 0.9 [SD 1.2] and mean -0.3 [SD 0.2], respectively; p < 0.05).
The results of this study show a trend favoring the use of AR over NV with respect to reducing contact between a clip applier and the perifocal structures during a simulated clipping of an intracranial aneurysm. Target-guided craniotomies were smaller with the use of AR. AR may be used not only to localize surgical targets but also to prevent complications associated with damage to structures encountered during the surgical approach.
颅内微创手术意味着在受关键结构（如血管和颅神经）包围的有限手术通道内进行操作。任何对这些结构的损伤都可能影响患者的预后。神经导航系统可能会降低发生此类并发症的风险。在这项研究中，作者旨在比较标准神经导航（NV）和增强现实（AR）引导导航在使用模拟颅内血管的新型模型进行神经外科入路时对病灶周围结构完整性的影响。
定制的盒子，内部有纵横交错的硬金属丝、底部有隐藏的钉子和木制顶部，进行了扫描、融合和参考。金属丝和动脉瘤夹放置器连接到一个控制器上，该控制器会计算它们之间的接触次数。23 名未经训练的参与者被要求 1）使用 NV 定义顶部的最佳进入点，在木制顶部上尽可能小地进行开颅，并在放置夹在钉子上而不接触金属丝时使用手术显微镜；2）使用 AR 预先定义理想的轨迹，导航手术显微镜，然后执行相同的任务。主要结果是金属丝和夹放置器之间的接触次数。次要结果是开颅大小，以及使用 NV 和 AR 避免接触金属丝的信任程度，使用 9 级 Likert 量表评估。
使用 AR 时，接触次数的中位数往往低于使用 NV（AR，中位数 1 [Q1：1，Q3：2]；NV，中位数 3 [Q1：1，Q3：6]；p = 0.074）。与使用 NV 相比，使用 AR 时，针对目标的开颅大小显著较小（AR，中位数 4.91cm2 [Q1：4.71cm2，Q3：7.55cm2]；NV，中位数 9.62cm2 [Q1：7.07cm2；Q3：13.85cm2]）。参与者对 AR 的信任度高于对 NV 的信任度（后测减去前测的差值分别为均值 0.9 [SD 1.2]和均值 -0.3 [SD 0.2]；p < 0.05）。
这项研究的结果表明，在模拟颅内动脉瘤夹闭过程中，与 NV 相比，AR 在减少夹放置器与病灶周围结构之间的接触方面具有优势。使用 AR 时，针对目标的开颅更小。AR 不仅可用于定位手术目标，还可用于防止与手术入路中遇到的结构损伤相关的并发症。
