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Xu Y, Li Z, Zhang Z, Zhang H, Liu P. Neuroendoscopy-Assisted Entire-Process Visualization Technique of Ventricular Puncture for External Ventricular Drainage. J Craniofac Surg 2024; 35:1201-1204. [PMID: 38829146 DOI: 10.1097/scs.0000000000010146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the feasibility, safety, and efficacy of the neuroendoscopy-assisted entire-process visualization technique (NEAEVT) of ventricular puncture for external ventricular drainage. METHODS Eighty-eight patients with cerebral hemorrhage who underwent unilateral ventricular puncture for external ventricular drainage in our hospital from June 2021 to June 2023 were analyzed. Patients were grouped according to puncture technique: NEAEVT (30 patients), freehand (30 patients), and laser-navigation-assisted (28 patients). Operation time, drainage tube placement, and catheter-related hemorrhage incidence were compared between the groups. RESULTS Mean operation time significantly differed between the freehand, NEAEVT, and laser-assisted groups (17.07, 18.37, and 34.04 min, respectively; P <0.0001). The position of the drainage tube was optimal or adequate in all patients of the NEAEVT group; optimal/adequate positioning was achieved in 80% of the freehand group. No catheter-related hemorrhage occurred in the NEAEVT group. Three freehand group patients and 2 laser-assisted group patients experienced catheter-related hemorrhage. CONCLUSION The NEAEVT of ventricular puncture is accurate and achieves ventricular drainage without significantly increasing surgical trauma, operation time, or incidence of hemorrhage.
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Affiliation(s)
- Yongqiang Xu
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, Shandong, China
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Alizadeh M, Xiao Y, Kersten-Oertel M. Virtual and Augmented Reality in Ventriculostomy: A Systematic Review. World Neurosurg 2024; 189:90-107. [PMID: 38823448 DOI: 10.1016/j.wneu.2024.05.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Ventriculostomy, one of the most common neurosurgical procedures, involves inserting a draining catheter into the brain's ventricular system to alleviate excessive cerebrospinal fluid accumulation. Traditionally, this procedure has relied on freehand techniques guided by anatomical landmarks, which have shown a high rate of misplacement. Recent advancements in virtual reality (VR) and augmented reality (AR) technologies have opened up new possibilities in the field. This comprehensive review aims to analyze the existing literature, examine the diverse applications of VR and AR in ventriculostomy procedures, address their limitations, and propose potential future directions. METHODS A systematic search was conducted in Web of Science and PubMed databases to identify studies employing VR and AR technologies in ventriculostomy procedures. Review papers, non-English records, studies unrelated to VR/AR technologies in ventriculostomy, and supplementary documents were excluded. In total 29 papers were included in the review. RESULTS The development of various VR and AR systems aimed at enhancing the ventriculostomy procedure are categorized according to the Data, Visualization and View taxonomy. The study investigates the data utilized by these systems, the visualizations employed, and the virtual or augmented environments created. Furthermore, the surgical scenarios and applications of each method, as well as the validation and evaluation metrics used, are discussed. DISCUSSION The review delves into the fundamental challenges encountered in the implementation of VR and AR systems in ventriculostomy. Additionally, potential future directions and areas for improvement are proposed, addressing the identified limitations and paving the way for further advancements in the field.
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Affiliation(s)
- Maryam Alizadeh
- Department of Computer Science and Software Engineering, Concordia University, Montreal, Quebec, Canada.
| | - Yiming Xiao
- Department of Computer Science and Software Engineering, Concordia University, Montreal, Quebec, Canada
| | - Marta Kersten-Oertel
- Department of Computer Science and Software Engineering, Concordia University, Montreal, Quebec, Canada
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Stahl R, D’Anastasi M, Forbrig R, Liebig T, Katzendobler S, Weller J, Trumm CG. Accuracy, Hemorrhagic Complications and CT Radiation Dose of Emergency External Ventricular Drain (EVD) Placement in Pediatric Patients: A 15-Year Retrospective Analysis. Diagnostics (Basel) 2023; 13:2805. [PMID: 37685340 PMCID: PMC10486425 DOI: 10.3390/diagnostics13172805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE To assess accuracy, the frequency of hemorrhagic complications and computed tomography (CT) radiation dose parameters in pediatric patients undergoing landmark-guided external ventricular drain (EVD) placement in an emergency setting. METHODS Retrospective analysis comprised 36 EVD placements with subsequent CT control scans in 29 patients (aged 0 to 17 years) in our university hospital from 2008 to 2022. The position of the EVD as well as the presence and extension of bleeding were classified according to previously established grading schemes. Dose length product (DLP), volume-weighted CT dose index (CTDIvol) and scan length were extracted from the radiation dose reports and compared to the diagnostic reference values (DRLs) issued by the German Federal Office for Radiation Protection. RESULTS After the initial EVD placement, optimal positioning of the catheter tip into the ipsilateral frontal horn or third ventricle (Grade I), or a functional positioning in the contralateral lateral ventricle or the non-eloquent cortex (Grade II), was achieved in 28 and 8 cases, respectively. In 32 of 36 procedures, no evidence of hemorrhage was present in the control CT scan. Grade 1 (<1 mL) and Grade 2 (≥1 to 15 mL) bleedings were detected after 3 and 1 placement(s), respectively. For control scans after EVD placements, CTDIvol (median [25%; 75% quartile]) was 39.92 [30.80; 45.55] mGy, DLP yielded 475.50 [375.00; 624.75] mGy*cm and the scan length result was 136 [120; 166] mm. Exceedances of the DRL values were observed in 14.5% for CTDIvol, 12.7% for DLP and 65.6% for the scan length. None of these values was in the range requiring a report to the national authorities. CONCLUSION Landmark-based emergency EVD placement in pediatric patients yielded an optimal position in most cases already after the initial insertion. Complications in terms of secondary hemorrhages are rare. CT dose levels associated with the intervention are below the reportable threshold of the national DRLs in Germany.
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Affiliation(s)
- Robert Stahl
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (C.G.T.)
| | - Melvin D’Anastasi
- Medical Imaging Department, Mater Dei Hospital, University of Malta, MSD 2090 Msida, Malta;
| | - Robert Forbrig
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (C.G.T.)
| | - Thomas Liebig
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (C.G.T.)
| | - Sophie Katzendobler
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (S.K.); (J.W.)
| | - Jonathan Weller
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (S.K.); (J.W.)
| | - Christoph G. Trumm
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (C.G.T.)
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Muacevic A, Adler JR, Laleva L, Nakov V, Spiriev T. Three-Dimensional Printing in Neurosurgery: A Review of Current Indications and Applications and a Basic Methodology for Creating a Three-Dimensional Printed Model for the Neurosurgical Practice. Cureus 2022; 14:e33153. [PMID: 36733788 PMCID: PMC9887931 DOI: 10.7759/cureus.33153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction Three-dimensional (3D) printing is an affordable aid that is useful in neurosurgery. It allows for better visualization and tactile appreciation of the individual anatomy and regions of interest and therefore potentially lowers the risk of complications. There are various applications of this technology in the field of neurosurgery. Materials and methods In this paper, we present a basic methodology for the creation of a 3D printed model using only open-source software for medical image editing, model generation, pre-printing preparation, and analysis of the literature concerning the practical use of this methodology. Results The literature review on the current applications of 3D printed models in neurosurgery shows that they are mostly used for preoperative planning, surgical training, and simulation, closely followed by their use in patient-specific implants and instrumentation and medical education. MaterialiseTM Mimics is the most frequently used commercial software for a 3D modeling for preoperative planning and surgical simulation, while the most popular open-source software for the same applications is 3D Slicer. In this paper, we present the algorithm that we employ for 3D printing using HorosTM, Blender, and Cura software packages which are all free and open-source. Conclusion Three-dimensional printing is becoming widely available and of significance to neurosurgical practice. Currently, there are various applications of this technology that are less demanding in terms of technical knowledge and required fluency in medical imaging software. These predispositions open the field for further research on the possible use of 3D printing in neurosurgery.
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Jean WC. Virtual and Augmented Reality in Neurosurgery: The Evolution of its Application and Study Designs. World Neurosurg 2022; 161:459-464. [PMID: 35505566 DOI: 10.1016/j.wneu.2021.08.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND As the art of neurosurgery evolves in the 21st century, more emphasis is placed on minimally invasive techniques, which require technical precision. Simultaneously, the reduction on training hours continues, and teachers of neurosurgery faces "double jeopardy"-with harder skills to teach and less time to teach them. Mixed reality appears as the neurosurgical educators' natural ally: Virtual reality facilitates the learning of spatial relationships and permits rehearsal of skills, while augmented reality can make procedures safer and more efficient. Little wonder then, that the body of literature on mixed reality in neurosurgery has grown exponentially. METHODS Publications involving virtual and augmented reality in neurosurgery were examined. A total of 414 papers were included, and they were categorized according to study design and analyzed. RESULTS Half of the papers were published within the last 3 years alone. Whereas in the earlier half, most of the publications involved experiments in virtual reality simulation and the efficacy of skills acquisition, many of the more recent publication are proof-of-concept studies. This attests to the evolution of mixed reality in neurosurgery. As the technology advances, neurosurgeons are finding more applications, both in training and clinical practice. CONCLUSIONS With parallel advancement in Internet speed and artificial intelligence, the utilization of mixed reality will permeate neurosurgery. From solving staff problems in global neurosurgery, to mitigating the deleterious effect of duty-hour reductions, to improving individual operations, mixed reality will have a positive effect in many aspects of neurosurgery.
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Affiliation(s)
- Walter C Jean
- Division of Neurological Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA; Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.
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Scott H, Griffin C, Coggins W, Elberson B, Abdeldayem M, Virmani T, Larson-Prior LJ, Petersen E. Virtual Reality in the Neurosciences: Current Practice and Future Directions. Front Surg 2022; 8:807195. [PMID: 35252318 PMCID: PMC8894248 DOI: 10.3389/fsurg.2021.807195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/30/2021] [Indexed: 01/05/2023] Open
Abstract
Virtual reality has made numerous advancements in recent years and is used with increasing frequency for education, diversion, and distraction. Beginning several years ago as a device that produced an image with only a few pixels, virtual reality is now able to generate detailed, three-dimensional, and interactive images. Furthermore, these images can be used to provide quantitative data when acting as a simulator or a rehabilitation device. In this article, we aim to draw attention to these areas, as well as highlight the current settings in which virtual reality (VR) is being actively studied and implemented within the field of neurosurgery and the neurosciences. Additionally, we discuss the current limitations of the applications of virtual reality within various settings. This article includes areas in which virtual reality has been used in applications both inside and outside of the operating room, such as pain control, patient education and counseling, and rehabilitation. Virtual reality's utility in neurosurgery and the neurosciences is widely growing, and its use is quickly becoming an integral part of patient care, surgical training, operative planning, navigation, and rehabilitation.
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Affiliation(s)
- Hayden Scott
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- *Correspondence: Hayden Scott
| | - Connor Griffin
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - William Coggins
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Brooke Elberson
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mohamed Abdeldayem
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Tuhin Virmani
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Linda J. Larson-Prior
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Erika Petersen
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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