1Department of Neurosurgery, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels.
2Research Group Center For Neurosciences (C4N-NEUR), Vrije Universiteit Brussel, Brussels.
Neurosurg Focus. 2021 Aug;51(2):E8. doi: 10.3171/2021.5.FOCUS21215.
OBJECTIVE: The traditional freehand technique for external ventricular drain (EVD) placement is most frequently used, but remains the primary risk factor for inaccurate drain placement. As this procedure could benefit from image guidance, the authors set forth to demonstrate the impact of augmented-reality (AR) assistance on the accuracy and learning curve of EVD placement compared with the freehand technique. METHODS: Sixteen medical students performed a total of 128 EVD placements on a custom-made phantom head, both before and after receiving a standardized training session. They were guided by either the freehand technique or by AR, which provided an anatomical overlay and tailored guidance for EVD placement through inside-out infrared tracking. The outcome was quantified by the metric accuracy of EVD placement as well as by its clinical quality. RESULTS: The mean target error was significantly impacted by either AR (p = 0.003) or training (p = 0.02) in a direct comparison with the untrained freehand performance. Both untrained (11.9 ± 4.5 mm) and trained (12.2 ± 4.7 mm) AR performances were significantly better than the untrained freehand performance (19.9 ± 4.2 mm), which improved after training (13.5 ± 4.7 mm). The quality of EVD placement as assessed by the modified Kakarla scale (mKS) was significantly impacted by AR guidance (p = 0.005) but not by training (p = 0.07). Both untrained and trained AR performances (59.4% mKS grade 1 for both) were significantly better than the untrained freehand performance (25.0% mKS grade 1). Spatial aptitude testing revealed a correlation between perceptual ability and untrained AR-guided performance (r = 0.63). CONCLUSIONS: Compared with the freehand technique, AR guidance for EVD placement yielded a higher outcome accuracy and quality for procedure novices. With AR, untrained individuals performed as well as trained individuals, which indicates that AR guidance not only improved performance but also positively impacted the learning curve. Future efforts will focus on the translation and evaluation of AR for EVD placement in the clinical setting.
目的：传统的脑室外引流（EVD）置管术是最常用的方法，但仍是导致引流管位置不准确的主要危险因素。由于该手术可以受益于图像引导，作者旨在证明与徒手技术相比，增强现实（AR）辅助对 EVD 置管的准确性和学习曲线的影响。
方法：16 名医学生在定制的头模上总共进行了 128 次 EVD 放置，在接受标准化培训课程前后都进行了操作。他们使用徒手技术或 AR 进行引导，AR 通过内部到外部的红外跟踪提供解剖覆盖和针对 EVD 放置的定制指导。通过 EVD 放置的准确性和临床质量来量化结果。
结果：与未经训练的徒手操作相比，AR（p = 0.003）或训练（p = 0.02）直接比较时，平均目标误差明显受到影响。未经训练的 AR（11.9 ± 4.5 mm）和训练的 AR（12.2 ± 4.7 mm）表现都明显优于未经训练的徒手表现（19.9 ± 4.2 mm），经过训练后有所改善（13.5 ± 4.7 mm）。通过改良 Kakarla 量表（mKS）评估的 EVD 放置质量明显受到 AR 引导的影响（p = 0.005），但不受训练的影响（p = 0.07）。未经训练的和训练的 AR 表现（两者均为 59.4% mKS 等级 1）都明显优于未经训练的徒手表现（25.0% mKS 等级 1）。空间能力测试显示，感知能力与未经训练的 AR 引导表现之间存在相关性（r = 0.63）。
结论：与徒手技术相比，EVD 置管的 AR 引导对新手来说，产生了更高的结果准确性和质量。使用 AR，未经训练的个体的表现与经过训练的个体一样好，这表明 AR 引导不仅提高了性能，而且对学习曲线产生了积极影响。未来的工作将集中于在临床环境中翻译和评估 AR 用于 EVD 置管。
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