Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Cluster of Excellence Matters of Activity, Image Space Material, Humboldt-Universität Zu Berlin, Berlin, Germany.
Acta Neurochir (Wien). 2022 Jan;164(1):3-14. doi: 10.1007/s00701-021-05045-1. Epub 2021 Dec 13.
Augmented reality (AR) has the potential to support complex neurosurgical interventions by including visual information seamlessly. This study examines intraoperative visualization parameters and clinical impact of AR in brain tumor surgery.
Fifty-five intracranial lesions, operated either with AR-navigated microscope (n = 39) or conventional neuronavigation (n = 16) after randomization, have been included prospectively. Surgical resection time, duration/type/mode of AR, displayed objects (n, type), pointer-based navigation checks (n), usability of control, quality indicators, and overall surgical usefulness of AR have been assessed.
AR display has been used in 44.4% of resection time. Predominant AR type was navigation view (75.7%), followed by target volumes (20.1%). Predominant AR mode was picture-in-picture (PiP) (72.5%), followed by 23.3% overlay display. In 43.6% of cases, vision of important anatomical structures has been partially or entirely blocked by AR information. A total of 7.7% of cases used MRI navigation only, 30.8% used one, 23.1% used two, and 38.5% used three or more object segmentations in AR navigation. A total of 66.7% of surgeons found AR visualization helpful in the individual surgical case. AR depth information and accuracy have been rated acceptable (median 3.0 vs. median 5.0 in conventional neuronavigation). The mean utilization of the navigation pointer was 2.6 × /resection hour (AR) vs. 9.7 × /resection hour (neuronavigation); navigation effort was significantly reduced in AR (P < 0.001).
The main benefit of HUD-based AR visualization in brain tumor surgery is the integrated continuous display allowing for pointer-less navigation. Navigation view (PiP) provides the highest usability while blocking the operative field less frequently. Visualization quality will benefit from improvements in registration accuracy and depth impression.
DRKS00016955.
增强现实（AR）技术具有通过无缝融合视觉信息来支持复杂神经外科手术的潜力。本研究旨在探讨 AR 技术在脑肿瘤手术中的术中可视化参数和临床应用效果。
55 例颅内病变患者被前瞻性纳入研究，患者随机分为 AR 导航显微镜组（n=39）或传统神经导航组（n=16）。评估手术切除时间、AR 的使用时长/类型/模式、显示对象数量（n，类型）、基于指针的导航检查次数（n）、控制的可用性、质量指标以及 AR 的整体手术实用性。
AR 显示仅用于 44.4%的切除时间。主要的 AR 类型是导航视图（75.7%），其次是目标体积（20.1%）。主要的 AR 模式是画中画（PiP）（72.5%），其次是 23.3%的覆盖显示。在 43.6%的情况下，重要解剖结构的视野被 AR 信息部分或完全遮挡。总共 7.7%的病例仅使用 MRI 导航，30.8%的病例使用 1 种，23.1%的病例使用 2 种，38.5%的病例使用 3 种或更多的物体分割进行 AR 导航。共有 66.7%的外科医生认为 AR 可视化在个别手术病例中是有帮助的。AR 的深度信息和准确性被认为是可接受的（中位数 3.0 与传统神经导航的中位数 5.0）。导航指针的平均使用次数为每切除小时 2.6 次（AR）与每切除小时 9.7 次（神经导航）；AR 导航显著减少了导航工作量（P<0.001）。
在脑肿瘤手术中，基于头戴式显示器（HUD）的 AR 可视化的主要优势是集成的连续显示，可实现无指针导航。导航视图（PiP）提供了最高的可用性，同时较少地遮挡手术视野。通过提高配准精度和深度印象，可视化质量将得到改善。
DRKS00016955。
