Isikay Ilkay, Cekic Efecan, Baylarov Baylar, Tunc Osman, Hanalioglu Sahin
Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
Neurosurgery Clinic, Polatli Duatepe State Hospital, Ankara, Türkiye.
Front Surg. 2024 Jul 16;11:1427844. doi: 10.3389/fsurg.2024.1427844. eCollection 2024.
Recent advances in medical imaging, computer vision, 3-dimensional (3D) modeling, and artificial intelligence (AI) integrated technologies paved the way for generating patient-specific, realistic 3D visualization of pathological anatomy in neurosurgical conditions. Immersive surgical simulations through augmented reality (AR), virtual reality (VR), mixed reality (MxR), extended reality (XR), and 3D printing applications further increased their utilization in current surgical practice and training. This narrative review investigates state-of-the-art studies, the limitations of these technologies, and future directions for them in the field of skull base surgery. We begin with a methodology summary to create accurate 3D models customized for each patient by combining several imaging modalities. Then, we explore how these models are employed in surgical planning simulations and real-time navigation systems in surgical procedures involving the anterior, middle, and posterior cranial skull bases, including endoscopic and open microsurgical operations. We also evaluate their influence on surgical decision-making, performance, and education. Accumulating evidence demonstrates that these technologies can enhance the visibility of the neuroanatomical structures situated at the cranial base and assist surgeons in preoperative planning and intraoperative navigation, thus showing great potential to improve surgical results and reduce complications. Maximum effectiveness can be achieved in approach selection, patient positioning, craniotomy placement, anti-target avoidance, and comprehension of spatial interrelationships of neurovascular structures. Finally, we present the obstacles and possible future paths for the broader implementation of these groundbreaking methods in neurosurgery, highlighting the importance of ongoing technological advancements and interdisciplinary collaboration to improve the accuracy and usefulness of 3D visualization and reality technologies in skull base surgeries.
医学成像、计算机视觉、三维（3D）建模和人工智能（AI）集成技术的最新进展为生成神经外科疾病中特定患者的、逼真的病理解剖3D可视化铺平了道路。通过增强现实（AR）、虚拟现实（VR）、混合现实（MxR）、扩展现实（XR）和3D打印应用进行的沉浸式手术模拟进一步提高了它们在当前手术实践和培训中的利用率。这篇叙述性综述调查了颅底外科领域中这些技术的最新研究、局限性以及未来发展方向。我们首先总结通过结合多种成像方式为每个患者创建精确3D模型的方法。然后，我们探讨这些模型如何应用于涉及前、中、后颅底的手术规划模拟和手术过程中的实时导航系统，包括内镜和开放显微手术操作。我们还评估它们对手术决策、手术表现和教育的影响。越来越多的证据表明，这些技术可以提高颅底神经解剖结构的可视性，并协助外科医生进行术前规划和术中导航，从而显示出改善手术结果和减少并发症的巨大潜力。在入路选择、患者体位、颅骨切开位置、避免误操作以及理解神经血管结构的空间相互关系方面可以实现最大效果。最后，我们介绍了在神经外科更广泛应用这些开创性方法的障碍和可能的未来路径，强调了持续技术进步和跨学科合作对于提高颅底手术中3D可视化和现实技术的准确性和实用性的重要性。
