Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
J Neurointerv Surg. 2023 Jul;15(7):708-711. doi: 10.1136/neurintsurg-2022-018678. Epub 2022 Jul 19.
Minimally invasive intracranial drain placement is a common neurosurgical emergency procedure in patients with intracerebral hemorrhage (ICH). We aimed to retrospectively investigate the accuracy of conventional freehand (bedside) hemorrhage drain placement and to prospectively compare the accuracy of augmented/mixed reality-guided (AR) versus frame-based stereotaxy-guided (STX) and freehand drain placement in a phantom model.
A retrospective, single-center analysis evaluated the accuracy of drain placement in 73 consecutive ICH with a visual rating of postinterventional CT data. In a head phantom with a simulated deep ICH, five neurosurgeons performed four punctures for each technique: STX, AR, and the freehand technique. The Euclidean distance to the target point and the lateral deviation of the achieved trajectory from the planned trajectory at target point level were compared between the three methods.
Analysis of the clinical cases revealed an optimal drainage position in only 46/73 (63%). Correction of the drain was necessary in 23/73 cases (32%). In the phantom study, accuracy of AR was significantly higher than the freehand method (P<0.001 for both Euclidean and lateral distances). The Euclidean distance using AR (median 3 mm) was close to that using STX (median 1.95 mm; P=0.023).
We demonstrated that the accuracy of the freehand technique was low and that subsequent position correction was common. In a phantom model, AR drainage placement was significantly more precise than the freehand method. AR has great potential to increase precision of emergency intracranial punctures in a bedside setting.
微创颅内引流放置是脑出血（ICH）患者常见的神经外科急症程序。我们旨在回顾性研究传统徒手（床边）血肿引流放置的准确性，并前瞻性比较增强/混合现实引导（AR）与基于框架立体定向（STX）和徒手引流放置在体模模型中的准确性。
一项回顾性、单中心分析评估了 73 例连续 ICH 患者的引流放置准确性，通过术后 CT 数据的视觉评分进行评估。在具有模拟深部 ICH 的头模中，五名神经外科医生为每种技术进行了四次穿刺：STX、AR 和徒手技术。比较了三种方法中目标点的欧几里得距离和目标点水平上实际轨迹与计划轨迹的横向偏差。
对临床病例的分析显示，只有 46/73（63%）例的引流位置最佳。73 例中有 23/73（32%）例需要纠正引流。在体模研究中，AR 的准确性明显高于徒手方法（欧几里得和横向距离均为 P<0.001）。AR 的欧几里得距离（中位数 3mm）接近 STX（中位数 1.95mm；P=0.023）。
我们证明了徒手技术的准确性较低，并且随后需要进行位置校正。在体模模型中，AR 引流放置明显比徒手方法更精确。AR 具有在床边环境中增加紧急颅内穿刺精度的巨大潜力。
