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Mishra R, Narayanan MK, Umana GE, Montemurro N, Chaurasia B, Deora H. Virtual Reality in Neurosurgery: Beyond Neurosurgical Planning. Int J Environ Res Public Health 2022; 19:ijerph19031719. [PMID: 35162742 PMCID: PMC8835688 DOI: 10.3390/ijerph19031719] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/29/2022] [Accepted: 01/30/2022] [Indexed: 02/04/2023]
Abstract
Background: While several publications have focused on the intuitive role of augmented reality (AR) and virtual reality (VR) in neurosurgical planning, the aim of this review was to explore other avenues, where these technologies have significant utility and applicability. Methods: This review was conducted by searching PubMed, PubMed Central, Google Scholar, the Scopus database, the Web of Science Core Collection database, and the SciELO citation index, from 1989–2021. An example of a search strategy used in PubMed Central is: “Virtual reality” [All Fields] AND (“neurosurgical procedures” [MeSH Terms] OR (“neurosurgical” [All Fields] AND “procedures” [All Fields]) OR “neurosurgical procedures” [All Fields] OR “neurosurgery” [All Fields] OR “neurosurgery” [MeSH Terms]). Using this search strategy, we identified 487 (PubMed), 1097 (PubMed Central), and 275 citations (Web of Science Core Collection database). Results: Articles were found and reviewed showing numerous applications of VR/AR in neurosurgery. These applications included their utility as a supplement and augment for neuronavigation in the fields of diagnosis for complex vascular interventions, spine deformity correction, resident training, procedural practice, pain management, and rehabilitation of neurosurgical patients. These technologies have also shown promise in other area of neurosurgery, such as consent taking, training of ancillary personnel, and improving patient comfort during procedures, as well as a tool for training neurosurgeons in other advancements in the field, such as robotic neurosurgery. Conclusions: We present the first review of the immense possibilities of VR in neurosurgery, beyond merely planning for surgical procedures. The importance of VR and AR, especially in “social distancing” in neurosurgery training, for economically disadvantaged sections, for prevention of medicolegal claims and in pain management and rehabilitation, is promising and warrants further research.
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Affiliation(s)
- Rakesh Mishra
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India;
| | | | - Giuseppe E. Umana
- Trauma and Gamma-Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95100 Catania, Italy;
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy
- Correspondence:
| | - Bipin Chaurasia
- Department of Neurosurgery, Bhawani Hospital, Birgunj 44300, Nepal;
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India;
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Lin J, Mou L, Yan Q, Ma S, Yue X, Zhou S, Lin Z, Zhang J, Liu J, Zhao Y. Automated Segmentation of Trigeminal Nerve and Cerebrovasculature in MR-Angiography Images by Deep Learning. Front Neurosci 2021; 15:744967. [PMID: 34955711 PMCID: PMC8702731 DOI: 10.3389/fnins.2021.744967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Trigeminal neuralgia caused by paroxysmal and severe pain in the distribution of the trigeminal nerve is a rare chronic pain disorder. It is generally accepted that compression of the trigeminal root entry zone by vascular structures is the major cause of primary trigeminal neuralgia, and vascular decompression is the prior choice in neurosurgical treatment. Therefore, accurate preoperative modeling/segmentation/visualization of trigeminal nerve and its surrounding cerebrovascular is important to surgical planning. In this paper, we propose an automated method to segment trigeminal nerve and its surrounding cerebrovascular in the root entry zone, and to further reconstruct and visual these anatomical structures in three-dimensional (3D) Magnetic Resonance Angiography (MRA). The proposed method contains a two-stage neural network. Firstly, a preliminary confidence map of different anatomical structures is produced by a coarse segmentation stage. Secondly, a refinement segmentation stage is proposed to refine and optimize the coarse segmentation map. To model the spatial and morphological relationship between trigeminal nerve and cerebrovascular structures, the proposed network detects the trigeminal nerve, cerebrovasculature, and brainstem simultaneously. The method has been evaluated on a dataset including 50 MRA volumes, and the experimental results show the state-of-the-art performance of the proposed method with an average Dice similarity coefficient, Hausdorff distance, and average surface distance error of 0.8645, 0.2414, and 0.4296 on multi-tissue segmentation, respectively.
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Affiliation(s)
- Jinghui Lin
- Department of Neurosurgery, Ningbo First Hospital, Ningbo, China
| | - Lei Mou
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Qifeng Yan
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Shaodong Ma
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Xingyu Yue
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Shengjun Zhou
- Department of Neurosurgery, Ningbo First Hospital, Ningbo, China
| | - Zhiqing Lin
- Department of Neurosurgery, Ningbo First Hospital, Ningbo, China
| | - Jiong Zhang
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Jiang Liu
- Department of Computer Science and Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Yitian Zhao
- The Affiliated People's Hospital of Ningbo University, Ningbo, China.,Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
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Zawy Alsofy S, Welzel Saravia H, Nakamura M, Ewelt C, Lewitz M, Sakellaropoulou I, Sarkis HM, Fortmann T, Schipmann S, Suero Molina E, Santacroce A, Salma A, Stroop R. Virtual reality-based evaluation of neurovascular conflict for the surgical planning of microvascular decompression in trigeminal neuralgia patients. Neurosurg Rev 2021; 44:3309-3321. [PMID: 33586035 DOI: 10.1007/s10143-021-01500-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/13/2020] [Accepted: 02/08/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is a lightning bolt of violent, electrifying, and stinging pain, often secondary to the neurovascular conflict (NVC). The vessels involved in NVC are mostly arteries and rarely veins. Evaluation of NVC in the deep infratentorial region is inseparably connected with cranial imaging. We retrospectively analyzed the potential influence of three-dimensional (3D) virtual reality (VR) reconstructions compared to conventional magnetic resonance imaging (MRI) scans on the evaluation of NVC for the surgical planning of microvascular decompression in patients with TN. METHODS Medical files were retrospectively analyzed regarding patient- and disease-related data. Preoperative MRI scans were retrospectively visualized via VR software to detect the characteristics of NVC. A questionnaire of experienced neurosurgeons evaluated the influence of VR visualization technique on identification of anatomical structures involved in NVC and on surgical strategy. RESULTS Twenty-four patients were included and 480 answer sheets were evaluated. Compared to conventional MRI, image presentation using 3D-VR modality significantly influenced the identification of the affected trigeminal nerve (p = 0.004), the vascular structure involved in the NVC (p = 0.0002), and the affected side of the trigeminal nerve (p = 0.005). CONCLUSIONS In patients with TN caused by NVC, the reconstruction of conventional preoperative MRI scans and the spatial and anatomical presentation in 3D-VR models offers the possibility of increased understanding of the anatomy and even more the underlying pathology, and thus influences operation planning and strategy.
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Affiliation(s)
- Samer Zawy Alsofy
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany. .,Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany.
| | - Heinz Welzel Saravia
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Makoto Nakamura
- Department of Neurosurgery, Academic Hospital Köln-Merheim, Witten/Herdecke University, Köln, Germany
| | - Christian Ewelt
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Marc Lewitz
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Ioanna Sakellaropoulou
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Hraq Mourad Sarkis
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Thomas Fortmann
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | | | - Eric Suero Molina
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Antonio Santacroce
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany.,Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Germany
| | - Asem Salma
- Department of Neurosurgery, St. Rita's Neuroscience Institute, Lima, Ohio, USA
| | - Ralf Stroop
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Fiani B, De Stefano F, Kondilis A, Covarrubias C, Reier L, Sarhadi K. Virtual Reality in Neurosurgery: "Can You See It?"-A Review of the Current Applications and Future Potential. World Neurosurg 2020; 141:291-8. [PMID: 32561486 DOI: 10.1016/j.wneu.2020.06.066] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/07/2020] [Accepted: 06/07/2020] [Indexed: 01/16/2023]
Abstract
Virtual reality (VR) technology had its early development in the 1960s in the U.S. Air Force and has since evolved into a budding area of scientific research with many practical medical purposes. From medical education to resident training to the operating room, VR has provided tangible benefits to learners and trainees and has also improved surgery through enhanced preoperative planning and efficiency in the operating room. Neurosurgery is a particularly complex field of medicine, in which VR has blossomed into a tool with great usefulness and promise. In spinal surgery, VR simulation has allowed for the practice of innovative minimally invasive procedures. In cranial surgery, VR has excelled in helping neurosurgeons design unique patient-specific approaches to particularly challenging tumor excisions. In neurovascular surgery, VR has helped trainees practice and perfect procedures requiring high levels of dexterity to minimize intraoperative complications and patient radiation exposure. In peripheral nerve surgery, VR has allowed surgeons to gain increased practice and comfort with complex microsurgeries such as nerve decompression. Overall, VR continues to increase its potential in neurosurgery and is poised to benefit patients in a multitude of ways. Although cost-prohibiting, legal, and ethical challenges surrounding this technology must be considered, future research and more direct quantitative outcome comparisons between standard and VR-supplemented procedures would help provide more direction regarding the feasibility of widespread adoption of VR technology in neurosurgery.
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Abstract
Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Type 1 as intermittent and Type 2 as constant pain represent distinct clinical, pathological, and prognostic entities. Although multiple mechanism involving peripheral pathologies at root (compression or traction), and dysfunctions of brain stem, basal ganglion, and cortical pain modulatory mechanisms could have role, neurovascular conflict is the most accepted theory. Diagnosis is essentially clinically; magnetic resonance imaging is useful to rule out secondary causes, detect pathological changes in affected root and neurovascular compression (NVC). Carbamazepine is the drug of choice; oxcarbazepine, baclofen, lamotrigine, phenytoin, and topiramate are also useful. Multidrug regimens and multidisciplinary approaches are useful in selected patients. Microvascular decompression is surgical treatment of choice in TN resistant to medical management. Patients with significant medical comorbidities, without NVC and multiple sclerosis are generally recommended to undergo gamma knife radiosurgery, percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation procedures. Partial sensory root sectioning is indicated in negative vessel explorations during surgery and large intraneural vein. Endoscopic technique can be used alone for vascular decompression or as an adjuvant to microscope. It allows better visualization of vascular conflict and entire root from pons to ganglion including ventral aspect. The effectiveness and completeness of decompression can be assessed and new vascular conflicts that may be missed by microscope can be identified. It requires less brain retraction.
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Affiliation(s)
- Yad Ram Yadav
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Yadav Nishtha
- Department of Radio Diagnosis and Imaging, All India Institute of Medical Science, New Delhi, India
| | - Pande Sonjjay
- Department of Radio Diagnosis and Imaging, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Parihar Vijay
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Ratre Shailendra
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Khare Yatin
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
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Abstract
BACKGROUND Common treatments for trigeminal neuralgia include percutaneous techniques, microvascular decompression, and Gamma Knife radiosurgery. Although microvascular decompression is considered the gold standard for treatment, percutaneous techniques remain an effective option for select patients. OBJECTIVE To review the historical development, advantages, and limitations of the most common percutaneous procedures for trigeminal neuralgia: balloon compression (BC), glycerol rhizotomy (GR), and radiofrequency thermocoagulation (RF). METHODS Publications reporting clinical outcomes after BC, GR, and RF were reviewed and included. Operative technique was based on the experience of the primary surgeon and senior author. RESULTS All 3 percutaneous techniques (BC, GR, and RF) provide effective pain relief but differ in method and specificity of nerve injury. BC selectively injures larger pain fibers while sparing small fibers and does not require an awake, cooperative patient. Pain control rates up to 91% at 6 months and 66% at 3 years have been reported. RF allows somatotopic nerve mapping and selective division lesioning and provides pain relief in up to 97% of patients initially and 58% at 5 years. Multiple treatments improve outcomes but carry significant morbidity risk. GR offers similar pain-free outcomes of 90% at 6 months and 54% at 3 years but with higher complication rates (25% vs. 16%) compared with BC. Advantages of percutaneous techniques include shorter procedure duration, minimal anesthesia risk, and in the case of GR and RF, immediate patient feedback. CONCLUSION Percutaneous treatments for trigeminal neuralgia remain safe, simple, and effective for achieving good pain control while minimizing procedural risk.
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Affiliation(s)
- Jason S Cheng
- *Department of Neurological Surgery, ‡Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, and §Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, California; ¶Department of Neurological Surgery, Indiana University School of Medicine, and Goodman Campbell Brain and Spine, Indianapolis, Indiana
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Cha J, Kim ST, Kim H, Choi JW, Kim HJ, Jeon P, Kim KH, Byun HS, Park K. Trigeminal neuralgia: Assessment with T2 VISTA and FLAIR VISTA fusion imaging. Eur Radiol 2011; 21:2633-9. [DOI: 10.1007/s00330-011-2216-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 06/01/2011] [Accepted: 06/22/2011] [Indexed: 10/17/2022]
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