Augmented reality simulation as training model of ventricular puncture: Evidence in the improvement of the quality of punctures

Augmented reality for external ventricular drain placement: Model alignment and integration software

Background

External ventricular drainage (EVD) is a critical neurosurgical procedure for managing conditions. Despite its widespread use, EVD placement is associated with specific risks, as improper catheter positioning can lead to severe complications. Recent advancements in augmented reality (AR) technology present new opportunities to improve the precision and safety of surgical interventions.

Methods

This study presents a new AR-assisted approach for EVD placement, utilizing the Microsoft HoloLens 2 and the Medgital software. We conducted a clinical trial involving three patients requiring EVD due to acute hydrocephalus or subarachnoid hemorrhage. The study adhered to ethical standards and was approved by an Ethics Committee, with informed consent obtained from all participants. Two alignment methods were employed: cranial landmark-based and QR code-based alignment. Preoperative imaging facilitated the creation of patient-specific 3D models, which were aligned with the patient's anatomy during surgery.

Results

The results suggest that AR navigation may improve the accuracy of catheter placement. In the first case, EVD was placed with a deviation of 2.3 mm from the planned trajectory, while the second and third cases achieved deviations of 1.5 mm and 0.5 mm, respectively. These results indicate the potential effectiveness of the AR system. Importantly, no postoperative complications were observed, suggesting the safety of the AR-guided approach.

Conclusion

This study suggests the viability of AR-assisted navigation in neurosurgical practice, particularly for EVD placement. The promising results support further exploration and integration of AR technologies in surgical settings, aiming to improve patient outcomes and procedural efficiency in neurosurgery.

Innovative technologies to address neglected tropical diseases in African settings with persistent sociopolitical instability

The health, economic, and social burden of neglected tropical diseases (NTDs) in Africa remains substantial, with elimination efforts hindered by persistent sociopolitical instability, including ongoing conflicts among political and ethnic groups that lead to internal displacement and migration. Here, we explore how innovative technologies can support Africa in addressing NTDs amidst such instability, through analysis of WHO and UNHCR data and a systematic literature review. Countries in Africa facing sociopolitical instability also bear a high burden of NTDs, with the continent ranking second globally in NTD burden (33%, 578 million people) and first in internal displacement (50%, 31.6 million people) in 2023. Studies have investigated technologies for their potential in NTD prevention, surveillance, diagnosis, treatment and management. Integrating the evidence, we discuss nine promising technologies-artificial intelligence, drones, mobile clinics, nanotechnology, telemedicine, augmented reality, advanced point-of-care diagnostics, mobile health Apps, and wearable sensors-that could enhance Africa's response to NTDs in the face of persistent sociopolitical instability. As stability returns, these technologies will evolve to support more comprehensive and sustainable health development. The global health community should facilitate deployment of health technologies to those in greatest need to help achieve the NTD 2030 Roadmap and other global health targets.

Case Report: Use of novel AR registration system for presurgical planning during vestibular schwannoma resection surgery

Background and importance

Vestibular schwannomas are benign tumors and are the most common tumor found in the cerebellopontine angle. Surgical management of these lesions involves consideration of various operative approaches, which can have profound effects on procedural course and patient outcomes. Therefore, a comprehensive understanding of the location of the tumor and surrounding anatomical structures is vital for a positive outcome. We present a case of a 47-year-old female patient with vestibular schwannoma. A novel mixed reality (MR) system was used to register patient-specific 3D models onto the patient's head for operative planning and anatomical visualization.

Case description

A 47-year-old female presented with a history of left-sided hearing loss, tinnitus, and episodic left facial tingling. Magnetic Resonance Imaging (MRI) demonstrated a 3.3 cm enhancing lesion in the left cerebellopontine angle at the with mass effect on the brachium pontis and medulla. Surgical resection was performed via retrosigmoid craniotomy.

Conclusions

In this study, we report the use of Augmented Reality (AR) visualization for planning of vestibular schwannoma resection. This technology allows for efficient and accurate registration of a patient's 3D anatomical model onto their head while positioned in the operating room. This system is a powerful tool for operative planning as it allows the surgeon to visualize critical anatomical structures where they lie on the patient's head. The present case demonstrates the value and use of AR for operative planning of complex cranial lesions.

Augmented Reality in Neurosurgery: A New Paradigm for Training

Augmented reality (AR) involves the overlay of computer-generated images onto the user's real-world visual field to modify or enhance the user's visual experience. With respect to neurosurgery, AR integrates preoperative and intraoperative imaging data to create an enriched surgical experience that has been shown to improve surgical planning, refine neuronavigation, and reduce operation time. In addition, AR has the potential to serve as a valuable training tool for neurosurgeons in a way that minimizes patient risk while facilitating comprehensive training opportunities. The increased use of AR in neurosurgery over the past decade has led to innovative research endeavors aiming to develop novel, more efficient AR systems while also improving and refining present ones. In this review, we provide a concise overview of AR, detail current and emerging uses of AR in neurosurgery and neurosurgical training, discuss the limitations of AR, and provide future research directions. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 386 articles were initially identified. Two independent reviewers (GH and AC) assessed article eligibility for inclusion, and 31 articles are included in this review. The literature search included original (retrospective and prospective) articles and case reports published in English between 2013 and 2023. AR assistance has shown promise within neuro-oncology, spinal neurosurgery, neurovascular surgery, skull-base surgery, and pediatric neurosurgery. Intraoperative use of AR was found to primarily assist with surgical planning and neuronavigation. Similarly, AR assistance for neurosurgical training focused primarily on surgical planning and neuronavigation. However, studies included in this review utilize small sample sizes and remain largely in the preliminary phase. Thus, future research must be conducted to further refine AR systems before widespread intraoperative and educational use.