Neumann Franziska, Grote Alexander, Gjorgjevski Marko, Carl Barbara, Knake Susanne, Menzler Katja, Nimsky Christopher, Bopp Miriam H A
Department of Neurosurgery, University Hospital Marburg, Philipps University Marburg, Baldingerstrasse, 35043 Marburg, Germany.
Department of Neurosurgery, Helios Dr. Horst Schmidt Kliniken, Ludwig-Erhard-Straße 100, 65199 Wiesbaden, Germany.
Sensors (Basel). 2025 Aug 26;25(17):5301. doi: 10.3390/s25175301.
Mesial temporal lobe epilepsy (mTLE) surgery, particularly selective amygdalohippocampectomy (sAHE), is a recognized treatment for pharmacoresistant temporal lobe epilepsy (TLE). Accurate intraoperative orientation is crucial for complete resection while maintaining functional integrity. This study evaluated the usability and effectiveness of multimodal neuronavigation and microscope-based augmented reality (AR) with intraoperative computed tomography (iCT) and navigated intraoperative ultrasound (iUS) in 28 patients undergoing resective surgery. Automatic iCT-based registration provided high initial navigation accuracy. Navigated iUS was utilized to verify navigational accuracy and assess the extent of resection during the procedure. AR support was successfully implemented in all cases, enhancing surgical orientation, surgeon comfort, and patient safety, while also aiding training and education. At one-year follow-up, 60.7% of patients achieved complete seizure freedom (ILAE Class 1), rising to 67.9% at the latest follow-up (median 4.6 years). Surgical complications were present in three cases (10.7%), but none resulted in permanent deficits. The integration of microscope-based AR with iCT and navigated iUS provides a precise and safe approach to resection in TLE surgery, additionally serving as valuable tool for neurosurgical training and education.
内侧颞叶癫痫（mTLE）手术，尤其是选择性杏仁核海马切除术（sAHE），是药物难治性颞叶癫痫（TLE）的一种公认治疗方法。准确的术中定位对于在保持功能完整性的同时进行完全切除至关重要。本研究评估了多模态神经导航和基于显微镜的增强现实（AR）与术中计算机断层扫描（iCT）和导航术中超声（iUS）在28例接受切除性手术患者中的可用性和有效性。基于自动iCT的配准提供了较高的初始导航精度。导航iUS用于在手术过程中验证导航精度并评估切除范围。在所有病例中均成功实施了AR支持，提高了手术定位、术者舒适度和患者安全性，同时也有助于培训和教育。在一年随访时，60.7%的患者实现了完全无癫痫发作（国际抗癫痫联盟1级），在最新随访时（中位时间4.6年）这一比例升至67.9%。3例（10.7%）出现手术并发症，但均未导致永久性神经功能缺损。基于显微镜的AR与iCT和导航iUS的整合为TLE手术切除提供了一种精确且安全的方法，此外还可作为神经外科培训和教育的宝贵工具。
