Virtual Reality for Preoperative Planning in Complex Surgical Oncology: A Single-Center Experience

Efficacy of virtual reality balance training on rehabilitation outcomes following anterior cruciate ligament reconstruction: A systematic review and meta-analysis

OBJECTIVE

The objective of this systematic review and meta-analysis is to clarify the rehabilitation efficacy of virtual reality (VR) balance training after anterior cruciate ligament reconstruction (ACLR).

METHODS

This meta-analysis was registered in PROSPERO with the registration number CRD42024520383. The electronic databases PubMed, Web of Science, Cochrane Library, MEDLINE, Embase, China National Knowledge Infrastructure, Chinese Biomedical Literature, China Science and Technology Journal Database, and Wanfang Digital Periodical database were systematically searched to identify eligible studies from their inception up to January 2024. The investigated outcomes included International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS), Holden grading, Extensor peak torque (EPT), Flexor peak torque (FPT), knee reaction time, knee reproduction angle difference. The pooled mean difference (MD) and 95% confidence intervals (CIs) were calculated using the random-effects model.

RESULTS

Six RCTs with a total of 464 patients after unilateral ACLR were included for 8-12 weeks of VR balance training intervention. Analysis of the results showed that compared with the conventional rehabilitation control group, the VR balance training group significantly improved the International Knee Documentation Committee (IKDC) score (MD = 3.88, 95%CI: 0.95~6.81), Holden grading (MD = 0.42, 95%CI: 0.33~0.51), Extensor peak torque (EPT) (MD = 12.03, 95%CI: 3.28~20.78)and Flexor peak torque (FPT) (MD = 14.57, 95%CI: 9.52~19.63) in postoperative ACLR patients, and significantly reduced knee reaction time (MD = -0.30, 95%CI: -0.35~-0.25), knee angle reproduction difference at 30° (MD = -0.88, 95%CI: -1.16~-0.61), knee angle reproduction difference at 60° (MD = -0.80, 95%CI: -1.09~-0.50), and VAS score (MD = -0.52, 95%CI: -0.65~-0.39).

CONCLUSION

Since many of the included results are based on low-or very-low-quality evidence, although the results show a certain trend, the conclusion has great uncertainty. In the rehabilitation training following ACLR and lower-limb balance training, the application of VR might be advantageous for the recovery of patients' knee joint function, lower-limb muscle strength, proprioception, and pain management. The level of immersion may influence the rehabilitation outcome. Because of the limitations in data quality and heterogeneity as well as the small sample size, the strength of the conclusions is weakened. These findings should be verified in further large-scale prospective studies.

SEEG4D: a tool for 4D visualization of stereoelectroencephalography data

Epilepsy is a prevalent and serious neurological condition which impacts millions of people worldwide. Stereoelectroencephalography (sEEG) is used in cases of drug resistant epilepsy to aid in surgical resection planning due to its high spatial resolution and ability to visualize seizure onset zones. For accurate localization of the seizure focus, sEEG studies combine pre-implantation magnetic resonance imaging, post-implant computed tomography to visualize electrodes, and temporally recorded sEEG electrophysiological data. Many tools exist to assist in merging multimodal spatial information; however, few allow for an integrated spatiotemporal view of the electrical activity. In the current work, we present SEEG4D, an automated tool to merge spatial and temporal data into a complete, four-dimensional virtual reality (VR) object with temporal electrophysiology that enables the simultaneous viewing of anatomy and seizure activity for seizure localization and presurgical planning. We developed an automated, containerized pipeline to segment tissues and electrode contacts. Contacts are aligned with electrical activity and then animated based on relative power. SEEG4D generates models which can be loaded into VR platforms for viewing and planning with the surgical team. Automated contact segmentation locations are within 1 mm of trained raters and models generated show signal propagation along electrodes. Critically, spatial-temporal information communicated through our models in a VR space have potential to enhance sEEG pre-surgical planning.

Comparison of virtual reality and computed tomography in the preoperative planning of complex tibial plateau fractures

INTRODUCTION

Preoperative planning is a critical step in the success of any complex surgery. The pur-pose of this study is to evaluate the advantage of VR glasses in surgical planning of complex tibial plateau fractures compared to CT planning.

MATERIALS AND METHODS

Five orthopedic surgeons performed preoperative planning for 30 fractures using either conventional CT slices or VR visualization with a VR headset. Planning was performed in a randomized order with a 3-month interval between planning sessions. A standardized questionnaire assessed planned operative time, planning time, fracture classification and understanding, and surgeons' subjective confidence in surgical planning.

RESULTS

The mean planned operative time of 156 (SD 47) minutes was significantly lower (p < 0.001) in the VR group than in the CT group (172 min; SD 44). The mean planning time in the VR group was 3.48 min (SD 2.4), 17% longer than in the CT group (2.98 min, SD 1.9; p = 0.027). Relevant parameters influencing planning time were surgeon experience (-0.61 min) and estimated complexity of fracture treatment (+ 0.65 min).

CONCLUSION

The use of virtual reality for surgical planning of complex tibial plateau fractures resulted in significantly shorter planned operative time, while planning time was longer compared to CT planning. After VR planning, more surgeons felt (very) well prepared for surgery.