Hunt Rachel, Scarpace Lisa, Rock Jack P
Neurosurgery, Henry Ford Health, Detroit, USA.
Neurosurgery, Henry Ford Health, Pittsburgh, USA.
Cureus. 2024 Apr 6;16(4):e57717. doi: 10.7759/cureus.57717. eCollection 2024 Apr.
Augmented reality (AR) is an emerging technology that can display three-dimensional patient anatomy in the surgeons' field of view. The use of this technology has grown considerably for both presurgical and intraoperative guidance. A patient diagnosed with breast cancer started to experience numbness in the left hand, which progressed to weakness in the left hand and arm. An MRI was performed demonstrating a 2.9 cm X 1.8 cm lesion with extensive surrounding edema in the posterior fronto-parietal lobes. Surgery was recommended for presumed metastatic disease. Preoperatively, an AR system and Brainlab navigation were registered to the patient. AR, traditional navigation, and ultrasound were all used to localize the lesion and determine the craniotomy site and size. The tumor was removed along the direction of the lesion. Intraoperatively, we used AR to reexamine the tumor details and could appreciate that we had to redirect our surgical trajectory anteriorly and laterally in order to follow along the main axis of the tumor. In doing this, we were able to more confidently remain with the tumor, which by this time was poorly defined by 2D navigation and by direct vision. Postoperative MRI confirmed gross total removal of the tumor. The patient had an uneventful postoperative course with resolution of preoperative symptoms and the final surgical pathology was grade 4 glioblastoma. Here, we describe the valuable use of AR for the resection of a glioma. The system has a seamless registration process and provides the surgeon with a unique view of 3D anatomy overlaid onto the patient's head. This exciting technology can add tremendous value to complex cranial surgeries.
增强现实(AR)是一项新兴技术,能够在外科医生的视野中显示三维患者解剖结构。这项技术在术前和术中引导方面的应用有了显著增长。一名被诊断为乳腺癌的患者开始出现左手麻木,随后发展为左手和手臂无力。进行了磁共振成像(MRI)检查,结果显示在额顶叶后部有一个2.9厘米×1.8厘米的病变,周围伴有广泛水肿。鉴于可能存在转移性疾病,建议进行手术。术前,将一个AR系统和Brainlab导航系统与患者进行了配准。AR、传统导航和超声均用于定位病变,并确定开颅部位和大小。沿着病变方向切除了肿瘤。术中,我们使用AR重新检查肿瘤细节,发现必须向前和向外侧调整手术轨迹,以便沿着肿瘤的主轴进行操作。通过这样做,我们能够更有信心地追踪肿瘤,而此时二维导航和直接视觉对肿瘤的界定并不清晰。术后MRI证实肿瘤已全部切除。患者术后恢复顺利,术前症状消失,最终手术病理结果为4级胶质母细胞瘤。在此,我们描述了AR在胶质瘤切除术中的宝贵应用。该系统具有无缝配准过程,并为外科医生提供了叠加在患者头部的独特三维解剖视图。这项令人兴奋的技术可为复杂的颅脑手术增添巨大价值。
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