Conventional image guidance systems have become the standard for planning in neurosurgical procedures. While these systems have been shown to increase accuracy and precision for a variety of cases, there are still drawbacks. Such limitations revolve around the use of multiple physical components to separately display the information and the substantial amount of training time required for residents to become familiar with these systems. These disadvantages can increase the difficulty of the surgery unnecessarily, and thus affect quality. To address these concerns, a mixed reality application was developed on the Microsoft HoloLens as a surgical planning and teaching tool. Neurosurgeons could see head, brain, and tumor holograms and create a craniotomy plan through hologram interaction. These interactions included the ability to rotate the head to its desired location, perform an image-to-physical registration, and utilize a virtual stylus to collect points for the surgical plan. Furthermore, the app was expanded to also track physical tools with an optical tracker to provide a more realistic surgical planning scenario. With a tracked stylus, the user was capable of selecting points on the physical head to perform a registration where the 3D neuroanatomy models properly appeared in the physical head as a virtually augmented structure. To evaluate the prototype, practicing neurosurgeons were provided a demonstration and then promptly interviewed to assess design and efficacy. The tool alignment procedure was also evaluated to quantify the calibration error. Initial responses indicated that the prototype could be an effective surgical teaching and planning tool for less-experienced neurosurgeons because it could allow neurosurgeons to view physical and image space simultaneously.
The quality of neurosurgical planning can become compromised by soft tissue deformations that occur during surgery (i.e., brain shift). Conventional image guidance systems do not consider these intraoperative changes. In recent efforts, model based strategies have been developed to estimate surgical load displacements and modify the patient’s data intraoperatively to account for brain shift. While the efficacy of the model has been previously established, there is also an opportunity to further assist surgical planning with this pipeline. To address this, a mobile application designed for an Android tablet was developed to display simulated brain shifts that would occur during brain tumor surgery. The application has two primary functions to facilitate planning: a patient positioning mode and a simulation mode. The patient positioning mode allows the neurosurgeon to load the patient’s preoperative MR data and create a surgical plan (i.e., head orientation and craniotomy location) for the procedure. The simulation mode then displays both the preoperative data and the model predicted brain shift as a function of the specified orientation from the patient positioning mode. Additionally, to account for positional variations between planning and procedural implementation, the simulation mode also displays solutions with additional perturbations to the planned positioning to estimate shift possibilities. To assess the simulation mode prototype, practicing neurosurgeons were provided a prototype demonstration and interviews were performed to evaluate efficacy and design. Due to computational rendering and 3D rotation shortcomings based on clinical feedback, the prototype was redesigned into a full mixed reality simulation app on the Microsoft HoloLens. Preliminary survey responses show that the prototype could be an impactful surgical planning tool, especially among neurosurgeons with less experience.
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