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Zhao X, Zhao H, Zheng W, Gohritz A, Shen Y, Xu W. Clinical evaluation of augmented reality-based 3D navigation system for brachial plexus tumor surgery. World J Surg Oncol 2024; 22:20. [PMID: 38233922 PMCID: PMC10792838 DOI: 10.1186/s12957-023-03288-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/26/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Augmented reality (AR), a form of 3D imaging technology, has been preliminarily applied in tumor surgery of the head and spine, both are rigid bodies. However, there is a lack of research evaluating the clinical value of AR in tumor surgery of the brachial plexus, a non-rigid body, where the anatomical position varies with patient posture. METHODS Prior to surgery in 8 patients diagnosed with brachial plexus tumors, conventional MRI scans were performed to obtain conventional 2D MRI images. The MRI data were then differentiated automatically and converted into AR-based 3D models. After point-to-point relocation and registration, the 3D models were projected onto the patient's body using a head-mounted display for navigation. To evaluate the clinical value of AR-based 3D models compared to the conventional 2D MRI images, 2 senior hand surgeons completed questionnaires on the evaluation of anatomical structures (tumor, arteries, veins, nerves, bones, and muscles), ranging from 1 (strongly disagree) to 5 (strongly agree). RESULTS Surgeons rated AR-based 3D models as superior to conventional MRI images for all anatomical structures, including tumors. Furthermore, AR-based 3D models were preferred for preoperative planning and intraoperative navigation, demonstrating their added value. The mean positional error between the 3D models and intraoperative findings was approximately 1 cm. CONCLUSIONS This study evaluated, for the first time, the clinical value of an AR-based 3D navigation system in preoperative planning and intraoperative navigation for brachial plexus tumor surgery. By providing more direct spatial visualization, compared with conventional 2D MRI images, this 3D navigation system significantly improved the clinical accuracy and safety of tumor surgery in non-rigid bodies.
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Affiliation(s)
- Xuanyu Zhao
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Branch of Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Huali Zhao
- Department of Radiology, Jing'an District Central Hospital, Branch of Huashan Hospital, Fudan University, Shanghai, China
| | - Wanling Zheng
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Branch of Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Andreas Gohritz
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Yundong Shen
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Branch of Huashan Hospital, Fudan University, Shanghai, China.
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.
- The National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China.
| | - Wendong Xu
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Branch of Huashan Hospital, Fudan University, Shanghai, China.
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.
- The National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China.
- Institute of Brain Science, State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China.
- Research Unit of Synergistic Reconstruction of Upper and Lower Limbs after Brain Injury, Chinese Academy of Medical Sciences, Beijing, China.
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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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Baldoncini M, Luzzi S, Almeida JP, Contreras-López WO, La Corte E, Ordóñez-Rubiano EG, Campero A. Surgical corridors to foramen magnum meningiomas: a mini-review. Front Neurol 2023; 14:1228285. [PMID: 37528861 PMCID: PMC10389656 DOI: 10.3389/fneur.2023.1228285] [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: 05/24/2023] [Accepted: 07/04/2023] [Indexed: 08/03/2023] Open
Abstract
Gross-total resection of foramen magnum meningiomas remains the gold standard of treatment and should be performed whenever possible. The transcondylar approach (and its variations) represents the most used approach for meningiomas located in the lateral or anterior borders of the foramen magnum. Endoscopic transclivus approaches represent a useful option in selected cases of anterior midline foramen magnum meningiomas, to be performed in centers with advanced experience in endoscopic skull base surgery, with the caveats of increased risk of postoperative cerebrospinal fluid leak. Alternatively, radiosurgery remains an option for well-selected cases, especially for the management of asymptomatic patients with small enlarging tumors. Advances in molecular profiling, as well as genetic analysis, may guide adjuvant treatment.
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Affiliation(s)
- Matias Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
- Department of Neurological Surgery, Hospital San Fernando, Buenos Aires, Argentina
| | - Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Joao P. Almeida
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, United States
| | - William Omar Contreras-López
- Functional Neurosurgery, NEMOD International Neuromodulation Center, Clínica Foscal Internacional, UNAB University, Bucaramanga, Colombia
| | - Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - 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
| | - Alvaro Campero
- Department of Neurological Surgery, Padilla Hospital, Tucumán, Argentina
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