Li Chi-Ruei, Shen Chiung-Chyi, Yang Meng-Yin, Tsuei Yuang-Seng, Lee Chung-Hsin
Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
Brain Sci. 2023 Apr 13;13(4):653. doi: 10.3390/brainsci13040653.
BACKGROUND: Intracranial arteriovenous malformations (AVMs) are lesions containing complex vessels with a lack of buffering capillary architecture which might result in hemorrhagic cerebrovascular accidents (CVAs). Intraoperative navigation can improve resection rates and functional preservation in patients with lesions in eloquent areas, but current systems have limitations that can distract the operator. Augmented Reality (AR) surgical technology can reduce these distractions and provide real-time information regarding vascular morphology and location. METHODS: In this case report, an adult patient was admitted to the emergency department after a fall, and diagnostic imaging revealed a Spetzler-Martin grade I AVM in the right parietal region with evidence of rupture. The patient underwent a stereotactic microsurgical resection with assistance from augmented reality technology, which allowed for a hologram of the angioarchitecture to be projected onto the cortical surface, aiding in the recognition of the angiographic anatomy during surgery. RESULTS: The patient's postoperative recovery went smoothly. At 6-month follow-up, the patient had remained in stable condition, experiencing complete relief from his previous symptoms. The follow-up examination also revealed complete obliteration of the AVMs without any remaining pathological vascular structure. CONCLUSIONS: AR-assisted microsurgery makes both the dissection and resection steps safer and more delicate. As several innovations are occurring in AR technology today, it is likely that this novel technique will be increasingly adopted in both surgical applications and education. Although certain limitations exist, this technique may still become more efficient and precise as this novel technology its continues to develop further.
背景:颅内动静脉畸形(AVM)是包含复杂血管且缺乏缓冲毛细血管结构的病变,这可能导致出血性脑血管意外(CVA)。术中导航可提高功能区病变患者的切除率并保留功能,但目前的系统存在局限性,可能会分散术者注意力。增强现实(AR)手术技术可减少这些干扰,并提供有关血管形态和位置的实时信息。 方法:在本病例报告中,一名成年患者跌倒后被送往急诊科,诊断性影像学检查显示右侧顶叶区域有一个Spetzler-Martin I级AVM,并有破裂迹象。患者在增强现实技术的辅助下接受了立体定向显微手术切除,该技术可将血管造影结构的全息图投射到皮质表面,有助于术中识别血管造影解剖结构。 结果:患者术后恢复顺利。在6个月的随访中,患者病情保持稳定,先前症状完全缓解。随访检查还显示AVM完全闭塞,无任何残留的病理性血管结构。 结论:AR辅助显微手术使解剖和切除步骤更安全、更精细。由于当今AR技术不断创新,这项新技术可能会在手术应用和教育中越来越多地被采用。尽管存在某些局限性,但随着这项新技术的不断发展,该技术可能会变得更加高效和精确。
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