gms | German Medical Science

Objective: The purpose of this study is to assess our clinical experiences using a novel AR navigation system, to help neurosurgeons with intra-operative visualization of lesion, surrounding eloquent structures, and lesion remnants. The usefulness, feasibility, and accuracy of this system were also evaluated.

Method: Patient-specific digital imaging data obtained from a variety of different diagnostic sources (magnetic resonance imaging, functional magnetic resonance imaging, magnetic resonance based diffusion tensor imaging) were collected and then transferred to a workstation. These clinical data were obtained from 780 patients who were suffering from either brain vascular malformations or tumors that were located in difficult brain sites. Volume images were reconstructed by three-dimensional (3D) viewer application. We used an optical tracking system for registration between volume image and body surface markers. The AR visualization was superimposed preoperative 3D multi-modal images onto microscopic surgical views. This system was applied to 780 cases of brain surgery.

Results: Multi-modal AR navigation was successfully applied in all cases. By using different head positioning systems and craniotomy options, we simulated microscopic visualizations of the lesion through numerous surgical approaches and from various angles of view. This simulation strategy enabled us to carry out an optimal approach and individually tailored craniotomy. Intra-operatively, this AR navigation system was very helpful to identify the lesion and surrounding eloquent structures. When tumor remnants were found with intra-operative MRI, this AR navigation system enabled quick and accurate localization of tumor remnants intra-operatively.

Conclusions: This navigation system provides real-time anatomical and functional information, which cannot be otherwise visualized without multi-modal AR navigation.