虚拟现实在介入性疼痛治疗术前规划中的应用：真实世界应用病例系列

: Virtual reality (VR), a component of extended reality (XR), has shown promise in pre-procedural planning by providing immersive, patient-specific simulations. In pain management, where precise anatomical understanding is critical for interventions such as peripheral nerve stimulation (PNS), nerve blocks, and intrathecal pump placement, the application of VR remains underexplored. This case series examines the role of VR in enhancing pre-procedural planning for complex chronic pain interventions. : From August 2022 to December 2024, six patients with anatomically challenging conditions underwent VR-assisted pre-procedural planning at Weill Cornell Medical Center. Patient-specific 3D models were created using the manual or automatic segmentation of imaging data and reviewed in VR to optimize procedural strategies by the surgeons performing the case. Procedures were then performed using conventional fluoroscopic or ultrasound guidance. : In all cases, VR facilitated the improved visualization of complex anatomies and informed optimal procedural trajectories. In patients with a complex cancer anatomy, previous surgical changes, or hardware, VR enabled precise PNS lead or needle placement, resulting in significant pain reductions postoperatively. In certain cases where previous interventional pain procedures had failed, VR allowed for a "second opinion" to develop an alternative approach with improved outcomes. Finally, in one case, VR served to potentially prevent patient harm by providing insight to the proceduralists regarding an alternative approach. Across the series, VR enhanced the spatial awareness, procedural accuracy, and confidence in navigating challenging anatomical scenarios. : This case series demonstrates the utility of VR in pre-procedural planning for chronic pain interventions. By enabling detailed anatomical visualization and trajectory optimization, VR has the potential to improve outcomes in complex cases. Further studies are needed to evaluate its broader clinical applications and cost-effectiveness in pain management.

虚拟现实（VR）作为扩展现实（XR）的一个组成部分，通过提供沉浸式、针对患者的模拟，在术前规划中展现出了前景。在疼痛管理领域，精确的解剖学理解对于诸如外周神经刺激（PNS）、神经阻滞和鞘内泵植入等干预措施至关重要，然而VR在这方面的应用仍未得到充分探索。本病例系列研究了VR在增强复杂慢性疼痛干预术前规划中的作用。

2022年8月至2024年12月，六名患有解剖结构复杂疾病的患者在威尔康奈尔医学院接受了VR辅助的术前规划。通过对成像数据进行手动或自动分割创建针对患者的3D模型，并在VR中进行查看，以便实施手术的外科医生优化手术策略。然后使用传统的荧光透视或超声引导进行手术。

在所有病例中，VR有助于更好地可视化复杂的解剖结构，并确定最佳的手术路径。对于患有复杂癌症解剖结构、既往有手术改变或体内有硬件植入的患者，VR能够精确放置PNS导线或针头，从而使术后疼痛显著减轻。在某些既往介入性疼痛治疗失败的病例中，VR提供了“第二种观点”，从而制定出效果更好的替代方法。最后，在一个病例中，VR通过向手术医生提供关于替代方法的见解，有可能避免对患者造成伤害。在整个病例系列中，VR增强了空间意识、手术准确性以及应对具有挑战性解剖场景的信心。

本病例系列证明了VR在慢性疼痛干预术前规划中的实用性。通过实现详细的解剖可视化和路径优化，VR有潜力改善复杂病例的治疗效果。需要进一步研究来评估其在疼痛管理中的更广泛临床应用和成本效益。