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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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Gonzalez-Segura A, Morales JM, Gonzalez-Darder JM, Cardona-Marsal R, Lopez-Gines C, Cerda-Nicolas M, Monleon D. Magnetic resonance microscopy at 14 Tesla and correlative histopathology of human brain tumor tissue. PLoS One 2011; 6:e27442. [PMID: 22110653 PMCID: PMC3216972 DOI: 10.1371/journal.pone.0027442] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 10/17/2011] [Indexed: 01/18/2023] Open
Abstract
Magnetic Resonance Microscopy (MRM) can provide high microstructural detail in excised human lesions. Previous MRM images on some experimental models and a few human samples suggest the large potential of the technique. The aim of this study was the characterization of specific morphological features of human brain tumor samples by MRM and correlative histopathology. We performed MRM imaging and correlative histopathology in 19 meningioma and 11 glioma human brain tumor samples obtained at surgery. To our knowledge, this is the first MRM direct structural characterization of human brain tumor samples. MRM of brain tumor tissue provided images with 35 to 40 µm spatial resolution. The use of MRM to study human brain tumor samples provides new microstructural information on brain tumors for better classification and characterization. The correlation between MRM and histopathology images allowed the determination of image parameters for critical microstructures of the tumor, like collagen patterns, necrotic foci, calcifications and/or psammoma bodies, vascular distribution and hemorrhage among others. Therefore, MRM may help in interpreting the Clinical Magnetic Resonance images in terms of cell biology processes and tissue patterns. Finally, and most importantly for clinical diagnosis purposes, it provides three-dimensional information in intact samples which may help in selecting a preferential orientation for the histopathology slicing which contains most of the informative elements of the biopsy. Overall, the findings reported here provide a new and unique microstructural view of intact human brain tumor tissue. At this point, our approach and results allow the identification of specific tissue types and pathological features in unprocessed tumor samples.
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Affiliation(s)
- Ana Gonzalez-Segura
- Fundación de Investigación del Hospital Clínico Universitario de Valencia/Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Jose Manuel Morales
- Unidad Central de Investigación en Medicina, Universitat de Valéncia, Valencia, Spain
| | | | - Ramon Cardona-Marsal
- Fundación de Investigación del Hospital Clínico Universitario de Valencia/Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | | | - Miguel Cerda-Nicolas
- Departamento de Patología, Universitat de Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-RES), Valencia, Spain
- * E-mail: (DM); (MCN)
| | - Daniel Monleon
- Fundación de Investigación del Hospital Clínico Universitario de Valencia/Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
- * E-mail: (DM); (MCN)
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