Jean Walter C, Piper Keaton, Felbaum Daniel R, Saez-Alegre Miguel
Division of Neurosurgery, Lehigh Valley Fleming Neuroscience Institute, Allentown , Pennsylvania , USA.
Department of Neurosurgery & Brain Repair, Morsani College of Medicine, University of South Florida, Tampa , Florida , USA.
Oper Neurosurg (Hagerstown). 2024 Jan 1;26(1):28-37. doi: 10.1227/ons.0000000000000908. Epub 2023 Sep 25.
Virtual reality (VR) refers to a computer-generated three-dimensional space in which a surgeon can interact with patient-specific anatomic models for surgical planning. Augmented reality (AR) is the technology that places computer-generated objects, including those made in VR, into the surgeon's visual space. Together, VR and AR are called mixed reality (MxR), and it is gaining importance in neurosurgery. MxR is helpful for selecting and creating templates for an optimal surgical approach and identifying key anatomic landmarks intraoperatively. By reporting our experience with the first 100 consecutive cases planned with VR and executed with AR, our objective is to detail the learning curve and encountered obstacles while adopting the new technology.
This series includes the first 100 consecutive complex cranial cases of a single surgeon for which MxR was intended for use. Effectiveness of the VR rehearsal and AR guidance was analyzed for four specific contributions: (1) opening size, (2) precise craniotomy placement, (3) guidance toward anatomic landmarks or target, and (4) antitarget avoidance. Seventeen cases in the study cohort were matched with historical non-MxR cases for comparison of outcome parameters. The cases in which MxR failed were plotted over time to determine the nature of the "learning curve."
AR guidance was abandoned in eight operations because of technical problems, but problem-free application of MxR increased between the 44th and 63rd cases. This provides some evidence of proficiency acquisition in between. Comparing the 17 pairs of matched MxR and non-MxR cases, no statistically significant differences exist in the groups regarding blood loss, length of stay nor duration of surgery. Cases where MxR had above-expectation performances are highlighted.
MxR is a powerful tool that can help tailor operations to patient-specific anatomy and provide efficient intraoperative guidance without additional time for surgery or hospitalization.
虚拟现实（VR）是指计算机生成的三维空间，外科医生可在其中与针对患者的解剖模型进行交互以制定手术计划。增强现实（AR）是一种将计算机生成的对象（包括在VR中创建的对象）置于外科医生视觉空间的技术。VR和AR合称为混合现实（MxR），其在神经外科手术中的重要性日益凸显。MxR有助于选择并创建最佳手术入路的模板，并在术中识别关键解剖标志。通过报告我们连续100例先用VR规划、后用AR实施手术的经验，我们旨在详细阐述采用这项新技术时的学习曲线及遇到的障碍。
本系列包括一位外科医生连续进行的首批100例复杂颅脑手术病例，这些病例旨在使用MxR。分析了VR预演和AR引导在四个特定方面的有效性：（1）开口大小；（2）精确的颅骨切开位置；（3）对解剖标志或靶点的引导；（4）避免非靶点。研究队列中的17例病例与历史非MxR病例进行匹配，以比较结果参数。将MxR失败的病例随时间绘制图表，以确定“学习曲线”的性质。
由于技术问题，8例手术中放弃了AR引导，但在第44例至第63例病例之间，MxR的无问题应用有所增加。这为在此期间熟练程度的获得提供了一些证据。比较17对匹配的MxR和非MxR病例，两组在失血量、住院时间和手术时长方面无统计学显著差异。突出显示了MxR表现超出预期的病例。
MxR是一种强大的工具，可帮助根据患者特定的解剖结构定制手术，并在不增加手术或住院时间的情况下提供有效的术中引导。
