Bopp Miriam H A, Saß Benjamin, Pojskić Mirza, Corr Felix, Grimm Dustin, Kemmling André, Nimsky Christopher
Department of Neurosurgery, University of Marburg, 35043 Marburg, Germany.
Marburg Center for Mind, Brain and Behavior (CMBB), 35032 Marburg, Germany.
J Clin Med. 2022 Sep 23;11(19):5590. doi: 10.3390/jcm11195590.
The aim of this study was to report on the clinical experience with microscope-based augmented reality (AR) in transsphenoidal surgery compared to the classical microscope-based approach. AR support was established using the head-up displays of the operating microscope, with navigation based on fiducial-/surface- or automatic intraoperative computed tomography (iCT)-based registration. In a consecutive single surgeon series of 165 transsphenoidal procedures, 81 patients underwent surgery without AR support and 84 patients underwent surgery with AR support. AR was integrated straightforwardly within the workflow. ICT-based registration increased AR accuracy significantly (target registration error, TRE, 0.76 ± 0.33 mm) compared to the landmark-based approach (TRE 1.85 ± 1.02 mm). The application of low-dose iCT protocols led to a significant reduction in applied effective dosage being comparable to a single chest radiograph. No major vascular or neurological complications occurred. No difference in surgical time was seen, time to set-up patient registration prolonged intraoperative preparation time on average by twelve minutes (32.33 ± 13.35 vs. 44.13 ± 13.67 min), but seems justifiable by the fact that AR greatly and reliably facilitated surgical orientation and increased surgeon comfort and patient safety, not only in patients who had previous transsphenoidal surgery but also in cases with anatomical variants. Automatic intraoperative imaging-based registration is recommended.
本研究的目的是报告与传统的基于显微镜的经蝶窦手术方法相比，基于显微镜的增强现实（AR）技术在经蝶窦手术中的临床经验。使用手术显微镜的抬头显示器建立AR支持，并基于基准/表面或基于术中自动计算机断层扫描（iCT）的配准进行导航。在一个由同一位外科医生连续进行的165例经蝶窦手术系列中，81例患者在没有AR支持的情况下接受手术，84例患者在有AR支持的情况下接受手术。AR被直接整合到手术流程中。与基于地标的方法（目标配准误差，TRE，1.85±1.02mm）相比，基于iCT的配准显著提高了AR的准确性（TRE，0.76±0.33mm）。低剂量iCT方案的应用导致有效剂量显著降低，与单次胸部X光检查相当。未发生重大血管或神经并发症。手术时间未见差异，设置患者配准的时间平均延长术中准备时间12分钟（32.33±13.35对44.13±13.67分钟），但鉴于AR不仅在既往接受过经蝶窦手术的患者中，而且在解剖变异的病例中，极大且可靠地促进了手术定位，提高了外科医生的舒适度和患者安全性，这似乎是合理的。建议采用基于术中自动成像的配准。
