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Kos TM, Colombo E, Bartels LW, Robe PA, van Doormaal TPC. Evaluation Metrics for Augmented Reality in Neurosurgical Preoperative Planning, Surgical Navigation, and Surgical Treatment Guidance: A Systematic Review. Oper Neurosurg (Hagerstown) 2023; 26:01787389-990000000-01007. [PMID: 38146941 PMCID: PMC11008635 DOI: 10.1227/ons.0000000000001009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/10/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Recent years have shown an advancement in the development of augmented reality (AR) technologies for preoperative visualization, surgical navigation, and intraoperative guidance for neurosurgery. However, proving added value for AR in clinical practice is challenging, partly because of a lack of standardized evaluation metrics. We performed a systematic review to provide an overview of the reported evaluation metrics for AR technologies in neurosurgical practice and to establish a foundation for assessment and comparison of such technologies. METHODS PubMed, Embase, and Cochrane were searched systematically for publications on assessment of AR for cranial neurosurgery on September 22, 2022. The findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS The systematic search yielded 830 publications; 114 were screened full text, and 80 were included for analysis. Among the included studies, 5% dealt with preoperative visualization using AR, with user perception as the most frequently reported metric. The majority (75%) researched AR technology for surgical navigation, with registration accuracy, clinical outcome, and time measurements as the most frequently reported metrics. In addition, 20% studied the use of AR for intraoperative guidance, with registration accuracy, task outcome, and user perception as the most frequently reported metrics. CONCLUSION For quality benchmarking of AR technologies in neurosurgery, evaluation metrics should be specific to the risk profile and clinical objectives of the technology. A key focus should be on using validated questionnaires to assess user perception; ensuring clear and unambiguous reporting of registration accuracy, precision, robustness, and system stability; and accurately measuring task performance in clinical studies. We provided an overview suggesting which evaluation metrics to use per AR application and innovation phase, aiming to improve the assessment of added value of AR for neurosurgical practice and to facilitate the integration in the clinical workflow.
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Affiliation(s)
- Tessa M. Kos
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisa Colombo
- Department of Neurosurgery, Clinical Neuroscience Center, Universitätsspital Zürich, Zurich, The Netherlands
| | - L. Wilbert Bartels
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pierre A. Robe
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tristan P. C. van Doormaal
- Department of Neurosurgery, Clinical Neuroscience Center, Universitätsspital Zürich, Zurich, The Netherlands
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Gómez Amarillo DF, Ordóñez-Rubiano EG, Ramírez-Sanabria AD, Figueredo LF, Vargas-Osorio MP, Ramon JF, Mejia JA, Hakim F. Augmented reality for intracranial meningioma resection: a mini-review. Front Neurol 2023; 14:1269014. [PMID: 38020666 PMCID: PMC10652283 DOI: 10.3389/fneur.2023.1269014] [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] [Received: 07/28/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Augmented reality (AR) integrates computer-generated content and real-world scenarios. Artificial intelligence's continuous development has allowed AR to be integrated into medicine. Neurosurgery has progressively introduced image-guided technologies. Integration of AR into the operating room has permitted a new perception of neurosurgical diseases, not only for neurosurgical planning, patient positioning, and incision design but also for intraoperative maneuvering and identification of critical neurovascular structures and tumor boundaries. Implementing AR, virtual reality, and mixed reality has introduced neurosurgeons into a new era of artificial interfaces. Meningiomas are the most frequent primary benign tumors commonly related to paramount neurovascular structures and bone landmarks. Integration of preoperative 3D reconstructions used for surgical planning into AR can now be inserted into the microsurgical field, injecting information into head-up displays and microscopes with integrated head-up displays, aiming to guide neurosurgeons intraoperatively to prevent potential injuries. This manuscript aims to provide a mini-review of the usage of AR for intracranial meningioma resection.
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Affiliation(s)
- Diego F. Gómez Amarillo
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Edgar G. Ordóñez-Rubiano
- Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José – Sociedad de Cirugía de Bogotá, Bogotá, Colombia
| | | | - Luisa F. Figueredo
- Healthy Brain Aging and Sleep Center (HBASC), Department of Psychiatry at NYU Langone School of Medicine, New York, NY, United States
| | - María P. Vargas-Osorio
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Juan F. Ramon
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Juan A. Mejia
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Fernando Hakim
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
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Hou X, Xu R, Chen L, Yang D, Li D. 3D color multimodality fusion imaging as an augmented reality educational and surgical planning tool for extracerebral tumors. Neurosurg Rev 2023; 46:280. [PMID: 37875636 DOI: 10.1007/s10143-023-02184-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/26/2023] [Accepted: 10/14/2023] [Indexed: 10/26/2023]
Abstract
Extracerebral tumors often occur on the surface of the brain or at the skull base. It is important to identify the peritumoral sulci, gyri, and nerve fibers. Preoperative visualization of three-dimensional (3D) multimodal fusion imaging (MFI) is crucial for surgery. However, the traditional 3D-MFI brain models are homochromatic and do not allow easy identification of anatomical functional areas. In this study, 33 patients with extracerebral tumors without peritumoral edema were retrospectively recruited. They underwent 3D T1-weighted MRI, diffusion tensor imaging (DTI), and CT angiography (CTA) sequence scans. 3DSlicer, Freesurfer, and BrainSuite were used to explore 3D-color-MFI and preoperative planning. To determine the effectiveness of 3D-color-MFI as an augmented reality (AR) teaching tool for neurosurgeons and as a patient education and communication tool, questionnaires were administered to 15 neurosurgery residents and all patients, respectively. For neurosurgical residents, 3D-color-MFI provided a better understanding of surgical anatomy and more efficient techniques for removing extracerebral tumors than traditional 3D-MFI (P < 0.001). For patients, the use of 3D-color MFI can significantly improve their understanding of the surgical approach and risks (P < 0.005). 3D-color-MFI is a promising AR tool for extracerebral tumors and is more useful for learning surgical anatomy, developing surgical strategies, and improving communication with patients.
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Affiliation(s)
- Xiaolin Hou
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 61173, China
| | - Ruxiang Xu
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 61173, China.
| | - Longyi Chen
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 61173, China.
| | - Dongdong Yang
- The Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dingjun Li
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 61173, China
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Ragnhildstveit A, Li C, Zimmerman MH, Mamalakis M, Curry VN, Holle W, Baig N, Uğuralp AK, Alkhani L, Oğuz-Uğuralp Z, Romero-Garcia R, Suckling J. Intra-operative applications of augmented reality in glioma surgery: a systematic review. Front Surg 2023; 10:1245851. [PMID: 37671031 PMCID: PMC10476869 DOI: 10.3389/fsurg.2023.1245851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
Background Augmented reality (AR) is increasingly being explored in neurosurgical practice. By visualizing patient-specific, three-dimensional (3D) models in real time, surgeons can improve their spatial understanding of complex anatomy and pathology, thereby optimizing intra-operative navigation, localization, and resection. Here, we aimed to capture applications of AR in glioma surgery, their current status and future potential. Methods A systematic review of the literature was conducted. This adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. PubMed, Embase, and Scopus electronic databases were queried from inception to October 10, 2022. Leveraging the Population, Intervention, Comparison, Outcomes, and Study design (PICOS) framework, study eligibility was evaluated in the qualitative synthesis. Data regarding AR workflow, surgical application, and associated outcomes were then extracted. The quality of evidence was additionally examined, using hierarchical classes of evidence in neurosurgery. Results The search returned 77 articles. Forty were subject to title and abstract screening, while 25 proceeded to full text screening. Of these, 22 articles met eligibility criteria and were included in the final review. During abstraction, studies were classified as "development" or "intervention" based on primary aims. Overall, AR was qualitatively advantageous, due to enhanced visualization of gliomas and critical structures, frequently aiding in maximal safe resection. Non-rigid applications were also useful in disclosing and compensating for intra-operative brain shift. Irrespective, there was high variance in registration methods and measurements, which considerably impacted projection accuracy. Most studies were of low-level evidence, yielding heterogeneous results. Conclusions AR has increasing potential for glioma surgery, with capacity to positively influence the onco-functional balance. However, technical and design limitations are readily apparent. The field must consider the importance of consistency and replicability, as well as the level of evidence, to effectively converge on standard approaches that maximize patient benefit.
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Affiliation(s)
- Anya Ragnhildstveit
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - Chao Li
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, England
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, England
| | | | - Michail Mamalakis
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - Victoria N. Curry
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Willis Holle
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Physics and Astronomy, The University of Utah, Salt Lake City, UT, United States
| | - Noor Baig
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, United States
| | | | - Layth Alkhani
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Biology, Stanford University, Stanford, CA, United States
| | | | - Rafael Romero-Garcia
- Department of Psychiatry, University of Cambridge, Cambridge, England
- Instituto de Biomedicina de Sevilla (IBiS) HUVR/CSIC/Universidad de Sevilla/CIBERSAM, ISCIII, Dpto. de Fisiología Médica y Biofísica
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, England
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Shaikh TA, Dar TR, Sofi S. A data-centric artificial intelligent and extended reality technology in smart healthcare systems. SOCIAL NETWORK ANALYSIS AND MINING 2022; 12:122. [PMID: 36065420 PMCID: PMC9434088 DOI: 10.1007/s13278-022-00888-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/08/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022]
Abstract
Extended reality (XR) solutions are quietly maturing, and their novel use cases are already being investigated, particularly in the healthcare industry. By 2022, the extended reality market is anticipated to be worth $209 billion. Certain diseases, such as Alzheimer's, Schizophrenia, Stroke rehabilitation stimulating specific areas of the patient's brain, healing brain injuries, surgeon training, realistic 3D visualization, touch-free interfaces, and teaching social skills to children with autism, have shown promising results with XR-assisted treatments. Similar effects have been used in video game therapies like Akili Interactive's EndeavorRx, which has previously been approved by the Food and Drug Administration (FDA) as a treatment regimen for children with attention deficit hyperactivity disorder (ADHD). However, while these improvements have received positive feedback, the field of XR-assisted patient treatment is in its infancy. The growth of XR in the healthcare sphere has the potential to transform the delivery of medical services. Imagine an elderly patient in a remote setting having a consultation with a world-renowned expert without ever having to leave their house. Rather than operating on cadavers in a medical facility, a surgical resident does surgery in a virtual setting at home. On the first try, a nurse uses a vein finder to implant an IV. Through cognitive treatment in a virtual world, a war veteran recovers from post-traumatic stress disorder (PTSD). The paper discusses the potential impact of XR in transforming the healthcare industry, as well as its use cases, challenges, XR tools and techniques for intelligent health care, recent developments of XR in intelligent healthcare services, and the potential benefits and future aspects of XR techniques in the medical domain.
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Clinical application of 3D Slicer combined with Sina/MosoCam multimodal system in preoperative planning of brain lesions surgery. Sci Rep 2022; 12:19258. [PMID: 36357434 PMCID: PMC9649692 DOI: 10.1038/s41598-022-22549-7] [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] [Received: 03/10/2022] [Accepted: 10/17/2022] [Indexed: 11/12/2022] Open
Abstract
To explore the clinical advantages of 3D Slicer combined with Sina/MosoCam multimodal system in preoperative planning of brain lesions surgery. By collecting the data of brain lesions patients undergoing craniotomy under the preoperative positioning of 3D Slicer combined Sina/MosoCam multimodal system in the people's Hospital of Wuhan University from January 2021 to October 2021, the preoperative planning of patients was introduced, and the size of surgical bone window, operation time, preoperative and postoperative neurological dysfunction were counted. We collected the case data of 35 patients who were reconstructed by 3D Slicer and located by Sina/MosoCam projection. There were 14 cases of malignant tumors (7 cases of glioma, 2 cases of diffuse large B-cell lymphoma, 5 cases of metastatic cancer) and 21 cases of benign tumors (17 cases of meningioma, 1 case of central neurocytoma, 2 cases of cavernous hemangioma and 1 case of arachnoid cyst). All 35 patients were located accurately before operation, the lesions were found quickly during operation, and the postoperative imaging data confirmed that the lesions were removed completely, of which 28 cases (80%) had significantly improved neurological symptoms one month after operation. 3D Slicer combined with Sina/MosoCam multimodal system has many advantages, such as simple and easy to learn, convenient operation, accurate positioning and free. It is considered to be a new technology that is practical, reliable, convenient for diagnosis and preoperative planning. It is suitable for popularization and use in neurosurgery and other operating rooms of all medical institutions.
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Zhang R, Alpdogan S, Kong S, Muhammad S. Application of computer-aided image reconstruction and image guide in parasagittal meningioma resection. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00157-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In recent years, smaller-sized (diameter < 2.5 cm) meningiomas are diagnosed due to increased cranial imaging. Symptomatic meningiomas need to be removed surgically. Therefore, it is extremely important to locate the lesion exactly to tailor the craniotomy especially if the neuro-navigation system is not available. Many hospitals located in the underdeveloped countries cannot afford the high costs of neuro-navigation equipment. Hence, it is relevant to discover low-cost associated and effective methods for lesion localization for surgery.
Methods
The use of localization markers in advance can help to acquire preoperative CT images of the patients to create and calculate a three-dimensional (3D) virtual graph using a computer. With the 3D graph, spatial distance of the tumor from the markers is calculated and the tumor location projected on the scalp by the Triangle Pythagorean theorem. This enables precise localization of intracranial microlesions preoperatively.
Results
The location of the tumor was consistent with that of the pre-operative virtual image, and the craniotomy was exact. The patient was discharged 3 days later without any neurological deficits.
Conclusions
This method is simple and reliable, inexpensive, and accurate in the location of small-sized lesions, which can partially compensate for the lack of neuro-navigation and is suitable for widespread application in hospitals in developing countries.
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Real-time augmented reality application in presurgical planning and lesion scalp localization by a smartphone. Acta Neurochir (Wien) 2022; 164:1069-1078. [PMID: 34448914 DOI: 10.1007/s00701-021-04968-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE A smartphone augmented reality (AR) application (app) was explored for clinical use in presurgical planning and lesion scalp localization. METHODS We programmed an AR App on a smartphone. The accuracy of the AR app was tested on a 3D-printed head model, using the Euclidean distance of displacement of virtual objects. For clinical validation, 14 patients with brain tumors were included in the study. Preoperative MRI images were used to generate 3D models for AR contents. The 3D models were then transferred to the smartphone AR app. Tumor scalp localization was marked, and a surgical corridor was planned on the patient's head by viewing AR images on the smartphone screen. Standard neuronavigation was applied to evaluate the accuracy of the smartphone. Max-margin distance (MMD) and area overlap ratio (AOR) were measured to quantitatively validate the clinical accuracy of the smartphone AR technique. RESULTS In model validation, the total mean Euclidean distance of virtual object displacement using the smartphone AR app was 4.7 ± 2.3 mm. In clinical validation, the mean duration of AR app usage was 168.5 ± 73.9 s. The total mean MMD was 6.7 ± 3.7 mm, and total mean AOR was 79%. CONCLUSIONS The smartphone AR app provides a new way of experience to observe intracranial anatomy in situ, and it makes surgical planning more intuitive and efficient. Localization accuracy is satisfactory with lesions larger than 15 mm.
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Chidambaram S, Stifano V, Demetres M, Teyssandier M, Palumbo MC, Redaelli A, Olivi A, Apuzzo MLJ, Pannullo SC. Applications of augmented reality in the neurosurgical operating room: A systematic review of the literature. J Clin Neurosci 2021; 91:43-61. [PMID: 34373059 DOI: 10.1016/j.jocn.2021.06.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/15/2022]
Abstract
Advancements in imaging techniques are key forces of progress in neurosurgery. The importance of accurate visualization of intraoperative anatomy cannot be overemphasized and is commonly delivered through traditional neuronavigation. Augmented Reality (AR) technology has been tested and applied widely in various neurosurgical subspecialties in intraoperative, clinical use and shows promise for the future. This systematic review of the literature explores the ways in which AR technology has been successfully brought into the operating room (OR) and incorporated into clinical practice. A comprehensive literature search was performed in the following databases from inception-April 2020: Ovid MEDLINE, Ovid EMBASE, and The Cochrane Library. Studies retrieved were then screened for eligibility against predefined inclusion/exclusion criteria. A total of 54 articles were included in this systematic review. The studies were sub- grouped into brain and spine subspecialties and analyzed for their incorporation of AR in the neurosurgical clinical setting. AR technology has the potential to greatly enhance intraoperative visualization and guidance in neurosurgery beyond the traditional neuronavigation systems. However, there are several key challenges to scaling the use of this technology and bringing it into standard operative practice including accurate and efficient brain segmentation of magnetic resonance imaging (MRI) scans, accounting for brain shift, reducing coregistration errors, and improving the AR device hardware. There is also an exciting potential for future work combining AR with multimodal imaging techniques and artificial intelligence to further enhance its impact in neurosurgery.
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Affiliation(s)
| | - Vito Stifano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University, Rome, Italy
| | - Michelle Demetres
- Samuel J. Wood & C.V. Starr Biomedical Information Center, Weill Cornell Medical, College/New York Presbyterian Hospital, New York, NY, USA
| | | | - Maria Chiara Palumbo
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University, Rome, Italy
| | | | - Susan C Pannullo
- Department of Neurosurgery, Weill Cornell Medical College, NY, USA.
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Fernandes de Oliveira Santos B, de Araujo Paz D, Fernandes VM, Dos Santos JC, Chaddad-Neto FEA, Sousa ACS, Oliveira JLM. Minimally invasive supratentorial neurosurgical approaches guided by Smartphone app and compass. Sci Rep 2021; 11:6778. [PMID: 33762597 PMCID: PMC7991647 DOI: 10.1038/s41598-021-85472-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 03/02/2021] [Indexed: 01/19/2023] Open
Abstract
The precise location in the scalp of specifically planned points can help to achieve less invasive approaches. This study aims to develop a smartphone app, evaluate the precision and accuracy of the developed tool, and describe a series of cases using the referred technique. The application was developed with the React Native framework for Android and iOS. A phantom was printed based on the patient's CT scan, which was used for the calculation of accuracy and precision of the method. The points of interest were marked with an "x" on the patient's head, with the aid of the app and a compass attached to a skin marker pen. Then, two experienced neurosurgeons checked the plausibility of the demarcations based on the anatomical references. Both evaluators marked the frontal, temporal and parietal targets with a difference of less than 5 mm from the corresponding intended point, in all cases. The overall average accuracy observed was 1.6 ± 1.0 mm. The app was used in the surgical planning of trepanations for ventriculoperitoneal (VP) shunts and for drainage of abscesses, and in the definition of craniotomies for meningiomas, gliomas, brain metastases, intracranial hematomas, cavernomas, and arteriovenous malformation. The sample consisted of 88 volunteers who exhibited the following pathologies: 41 (46.6%) had brain tumors, 17 (19.3%) had traumatic brain injuries, 16 (18.2%) had spontaneous intracerebral hemorrhages, 2 (2.3%) had cavernomas, 1 (1.1%) had arteriovenous malformation (AVM), 4 (4.5%) had brain abscesses, and 7 (7.9%) had a VP shunt placement. In cases approached by craniotomy, with the exception of AVM, straight incisions and minicraniotomy were performed. Surgical planning with the aid of the NeuroKeypoint app is feasible and reliable. It has enabled neurological surgeries by craniotomy and trepanation in an accurate, precise, and less invasive manner.
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Affiliation(s)
- Bruno Fernandes de Oliveira Santos
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, SE, Brazil. .,Unimed Sergipe Hospital, Aracaju, SE, Brazil. .,Clinic and Hospital São Lucas / Rede D`Or São Luiz, Aracaju, SE, Brazil. .,Department of Neurosurgery, Hospital de Cirurgia, Aracaju, SE, Brazil.
| | - Daniel de Araujo Paz
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Antonio Carlos Sobral Sousa
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, SE, Brazil.,Department of Internal Medicine, Federal University of Sergipe, Aracaju, SE, Brazil.,Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju, SE, Brazil.,Clinic and Hospital São Lucas / Rede D`Or São Luiz, Aracaju, SE, Brazil
| | - Joselina Luzia Menezes Oliveira
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, SE, Brazil.,Department of Internal Medicine, Federal University of Sergipe, Aracaju, SE, Brazil.,Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju, SE, Brazil.,Clinic and Hospital São Lucas / Rede D`Or São Luiz, Aracaju, SE, Brazil
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Sveinsson B, Koonjoo N, Rosen MS. ARmedViewer, an augmented-reality-based fast 3D reslicer for medical image data on mobile devices: A feasibility study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 200:105836. [PMID: 33250281 DOI: 10.1016/j.cmpb.2020.105836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/08/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Medical images obtained by methods such as magnetic resonance imaging (MRI) or computed tomography (CT) are typically displayed as a stack of 2D slices, comprising a 3D volume. Often, the anatomy of interest does not fall neatly into the slice plane but rather extends obliquely through several slices. Reformatting the data to show the anatomy in one slice in conventional medical imaging software can require expertise and time. In this work, we present ARmedViewer, a medical image viewing app designed for mobile devices that uses augmented reality technology to display medical image data. An arbitrary plane for displaying the data can be chosen quickly and intuitively by moving the mobile device. METHODS The app ARmedViewer, compiled for an iOS device, was designed to allow a user to easily select from a list of 3D image datasets consisting of header information and image data. The user decides where to place the data, which can be overlaid on actual human anatomy. After loading the dataset, the user can move and rotate the data as desired. 15 users compared the user experience of the app to a common image viewer by answering two user surveys each, one custom and one standardized. The utility of the app was also tested by having two users find a plane through a 3D dataset that displayed 3 randomly placed lesions. This operation was timed and compared between the app and a standard medical image viewer. RESULTS ARmedViewer was successfully developed and run on an iPhone XS. User interfaces for selecting, placing, moving, reslicing, and displaying the data were operated with ease, even by naïve users. The custom user survey indicated that freely selecting a slice through the data was significantly more intuitive and easier using the app than using a conventional image viewer on a computer workstation, and changing the viewing angle was also significantly more intuitive. The standardized survey indicated a significantly better user experience for the app in several categories, and never significantly worse. The timed reslicing experiments demonstrated the app being faster than the standard image viewer by an average factor of 9. CONCLUSIONS The newly developed ARmedViewer is a portable software tool for easily displaying 3D medical image data overlaid on human anatomy, allowing for easy choice of the viewing plane by intuitively moving the mobile device.
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Affiliation(s)
- Bragi Sveinsson
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States of America.
| | - Neha Koonjoo
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States of America
| | - Matthew S Rosen
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States of America; Department of Physics, Harvard University, Cambridge, United States of America
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Hou X, Yang DD, Li D, Zeng L, Li C. 3D Slicer and Sina appilication for surgical planning of giant invasive spinal schwannoma with scoliosis: A case report and literature review. Neurochirurgie 2020; 66:396-399. [DOI: 10.1016/j.neuchi.2020.06.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/14/2020] [Accepted: 06/28/2020] [Indexed: 02/07/2023]
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Enhancing Reality: A Systematic Review of Augmented Reality in Neuronavigation and Education. World Neurosurg 2020; 139:186-195. [DOI: 10.1016/j.wneu.2020.04.043] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/06/2020] [Indexed: 12/11/2022]
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A new simple brain segmentation method for extracerebral intracranial tumors. PLoS One 2020; 15:e0230754. [PMID: 32302315 PMCID: PMC7164623 DOI: 10.1371/journal.pone.0230754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 03/07/2020] [Indexed: 12/01/2022] Open
Abstract
Normal brain segmentation is available via FreeSurfer, Vbm, and Ibaspm software. However, these software packages cannot perform segmentation of the brain for patients with brain tumors. As we know, damage from extracerebral tumors to the brain occurs mainly by way of pushing and compressing while leaving the structure of the brain intact. Three-dimensional (3D) imaging, augmented reality (AR), and virtual reality (VR) technology have begun to be applied in clinical practice. The free medical open-source software 3D Slicer allows us to perform 3D simulations on a computer and requires little user interaction. Moreover, 3D Slicer can integrate with the third-party software mentioned above. The relationship between the tumor and surrounding brain tissue can be judged, but accurate brain segmentation cannot be performed using 3D Slicer. In this study, we combine 3D Slicer and FreeSurfer to provide a novel brain segmentation method for extracerebral tumors. This method can help surgeons identify the “real” relationship between the lesion and adjacent brain tissue before surgery and improve preoperative planning.
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Mikhail M, Mithani K, Ibrahim GM. Presurgical and Intraoperative Augmented Reality in Neuro-Oncologic Surgery: Clinical Experiences and Limitations. World Neurosurg 2019; 128:268-276. [PMID: 31103764 DOI: 10.1016/j.wneu.2019.04.256] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 02/06/2023]
Abstract
Virtual reality (VR) and augmented reality (AR) represent novel adjuncts for neurosurgical planning in neuro-oncology. In addition to established use in surgical and medical training, VR/AR are gaining traction for clinical use preoperatively and intraoperatively. To understand the utility of VR/AR in the clinical setting, we conducted a literature search in Ovid MEDLINE and EMBASE with various search terms designed to capture the use of VR/AR in neurosurgical procedures for resection of cranial tumors. The search retrieved 302 articles, of which 35 were subjected to full-text review; 19 full-text articles were included in the review. Key findings highlighted by the individual authors were extracted and summarized into themes to present the value of VR/AR in the clinical setting. These studies included various VR/AR systems applied to surgeries involving heterogeneous pathologies and outcome measures. Overall, VR/AR were found to be qualitatively advantageous due to enhanced visualization of complex anatomy and improved intraoperative lesion localization. When these technologies were compared with existing neuronavigation systems, quantitative clinical benefits were also reported. The capacity to visualize three-dimensional images superimposed on patient anatomy is a potentially valuable tool in complex neurosurgical environments. Surgical limitations may be addressed through future advances in image registration and tracking as well as intraoperatively acquired imaging with the ability to yield real-time virtual models.
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Affiliation(s)
- Mirriam Mikhail
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Karim Mithani
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Bergeron D, Iorio-Morin C, Bigder M, Dakson A, Eagles ME, Elliott CA, Honey CM, Kameda-Smith MM, Persad ARL, Touchette CJ, Tso MK, Fortin D. Mobile Applications in Neurosurgery: A Systematic Review, Quality Audit, and Survey of Canadian Neurosurgery Residents. World Neurosurg 2019; 127:e1026-e1038. [PMID: 30980978 DOI: 10.1016/j.wneu.2019.04.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND In the past decade, smartphone applications (Apps) have experienced remarkable development across all fields of medicine, including neurosurgery. However, owing to a lack of regulatory oversight and peer review, a clear need exists for a comprehensive review and audit of the existing available Apps. In the present study, we systematically reviewed the existing mobile Apps in neurosurgery, evaluated their clinical use by neurosurgery residents in Canada, and performed a quality audit of the most popular Apps. METHODS Indexed Apps were identified from either the Google Play Store or the iOS App Store using a comprehensive list of keywords related to neurosurgery. A subsequent cross-sectional survey of 76 Canadian neurosurgery residents was conducted, including a section on smartphone App use. We next evaluated the most popular Apps among the residents using the Healthcare Smartphone App Evaluation Tool and performed a quality audit of their content using established medical references. RESULTS The survey identified 118 mobile Apps related to neurosurgery. The 3 most used Apps used by the current cohort of Canadian neurosurgery residents were Neurosurgery Survival Guide, Neuromind, and the Journal of Neurosurgery App. Each of these 3 Apps received an excellent score on the Healthcare Smartphone App Evaluation Tool. A quality audit of 30 pages of the Neurosurgery Survival Guide and 40 clinical scores of the Neuromind App, performed by 10 neurosurgery residents, failed to reveal inaccurate or false statements. CONCLUSION The present study has highlighted the current landscape of neurosurgery mobile Apps and their use among neurosurgery residents.
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Affiliation(s)
- David Bergeron
- Division of Neurosurgery, Université de Montréal, Montréal, Quebec, Canada
| | | | - Mark Bigder
- Division of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ayoub Dakson
- Division of Neurosurgery, University of Dalhousie, Halifax, Nova Scotia, Canada
| | - Matthew E Eagles
- Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Cameron A Elliott
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - C Michael Honey
- Division of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Amit R L Persad
- Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Charles J Touchette
- Division of Neurosurgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Michael K Tso
- Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - David Fortin
- Division of Neurosurgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Chen J, Zhang D, Li Z, Dong Y, Han K, Wang J, Hou L. Lateral Ventricular Volume Asymmetry Predicts Poor Outcome After Spontaneous Intracerebral Hemorrhage. World Neurosurg 2018; 110:e958-e964. [DOI: 10.1016/j.wneu.2017.11.149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/23/2017] [Accepted: 11/25/2017] [Indexed: 02/03/2023]
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