Neurosurgery: VR and AR surgical planning research

“There were no intraoperative complications in any patient.”

“In 5 pediatric patients with complex MCA aneurysmal malformations (mean age = 33.2 ± 49.9 months), preoperative 3-dimensional (3D) interactive modeling informed treatment planning and enhanced surgeon understanding of the vascular pathology.”

“The 3D-VR modality significantly influenced the detection of tumor-related anatomical structures (p = 0.002), recommended head positioning (p = 0.005), and surgical approach (p = 0.03).”

p = 0.005

“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).”

p = 0.004

“The mean procedure time was significantly lower for the VR group compared with the control group (247.80 minutes vs 328.27 minutes; p = 0.0115), particularly for the patients with a CC score of 2 (95% CI, p = 0.0064).”

p = 0.0115

“A total of 134 cases were performed.”

134

“Image presentation using VR had a significant influence on the recommended surgical approach (P = 0.02), but no influence on the recommended patient positioning (P = 0.37) or placement of craniotomy (P = 0.09).”

P = 0.02

“The 3D-VR modality significantly influenced detection of the aneurysm-related vascular structure (p = 0.0001), the recommended head positioning (p = 0.005), and the surgical approach (p = 0.001) in the planning of microsurgical clipping.”

p = 0.001

“Surgical simulation and surgery program of VR of the 35 patients were successfully performed.”

“The systematic evaluation yielded a highly positive total score of +1.7.”

+1.7

“Survey results from 18 faculty members regarding seven questions indicated that AREP was user-friendly and can be effective in presurgical planning moving forward.”

“These results also reflect the subjective perception of the five trainee-pilot group which report a progressive confidence on the surgical case management.”

“Ten participants (2 Anaesthetists, 5 Neurosurgical trainees, 2 Speech therapists, 1 Neuropsychologist) completed System Usability Scale assessments, reporting a mean score of 71.5.”

71.5

“Skull position significantly changed in 5 out of 6 cases after 3D-AR view (P < 0.05, 20° angular adjustment).”

5 out of 6 cases

“There was overall positive feedback from participants regarding VR use, and most participants wanted VR to become a routine part of operative planning.”

“Where quantitative outcomes were reported, improvements most commonly involved planning accuracy, task efficiency (e.g., clip/operative time), and user-rated usefulness; patient-level outcomes were infrequently reported and variably defined.”

“However, challenges like high costs, lack of haptic feedback, and steep learning curves limit widespread use.”

“High cost, lack of numerous skilled operators, user discomfort, and no proper ethical protocols are critical hindrances that need to be addressed.”

“Furthermore, XR-enhanced patient communication tools have improved comprehension of complex neurosurgical procedures and informed consent quality.”

“VR-based three-dimensional reconstructions were consistently associated with improved preoperative spatial orientation and anatomical landmark recognition.”

“Augmented reality has demonstrated varying degrees of effectiveness, with mean registration accuracy reported between 2.5 and 10.75 mm.”

“The increasing use of such innovative technologies has completely changed the way to approach a lesion, using 3D visualization to foster a better understanding of its anatomical and vascular characteristics.”

“Surgeons involved in separating craniopagus twins have increasingly utilized tools such as CAD/CAM models, VSP and AR/VR to plan and execute successful separation, and these tools are associated with higher success rates than historical controls.”

“A positive impact on surgical planning was documented by 19 studies (67.9%)…”

67.9%

“The majority (82%) included cranial based applications related to tumor surgery with 34% showing improved resection rates and functional outcomes.”

34%

“In cranial surgery, VR has excelled in helping neurosurgeons design unique patient-specific approaches to particularly challenging tumor excisions.”

“The capacity to visualize three-dimensional images superimposed on patient anatomy is a potentially valuable tool in complex neurosurgical environments.”

“In terms of surgical planning, VR has noted and documented usefulness in the planning of cranial surgeries.”

“VR holds the promise of providing a useful educational tool for neurosurgical residents to hone their surgical skills and for neurosurgeons to rehearse specific segments of the surgery prior to the actual operation.”

“The final separation, completed in 2 stages over 31 hours, resulted in successful independent circulations and recovery.”

“An expert study across four common brain tumor locations demonstrated that the MOO model significantly outperformed manual methods in satisfying safety criteria.”

“The integrated simulation reshaped the multistep approach, allowing venous partition strategies and refined cranial reconstruction planning to be discussed, replicated, and enhanced multidisciplinarily.”

“The mean total preparation time (mean ± standard deviation, SD) was 40.6 ± 10.3 min for MR-HMD visualization and 108.8 ± 17.8 min for 3D-printed models, excluding printing, washing, and curing time.”

40.6 ± 10.3 min

“The system reduces the surgical planning time by 91%.”

91%

“This technological setup was employed for pre-operative and intraoperative planning and further enhanced clinical decision-making for the actual tumor resection.”

“The multi-layered and 3D model of the ST system facilitates epilepsy decision-making for both diagnosis and treatment, enhances surgical navigation, and even allows, in a robust virtual reality (VR) environment, the practice of complex surgical procedures.”

“Preoperative modeling required 15.3 ± 5.1 min, while AR navigation averaged 12.7 ± 3.2 min.”

15.3 ± 5.1 min

“AR guidance was abandoned in eight operations because of technical problems, but problem-free application of MxR increased between the 44th and 63rd cases.”

“The patient was discharged home on postoperative day 3 with no complications.”

“Overall, users felt the 3D models felt realistic (4.5/5), that the display of the user's real-world view felt natural (4.3/5), and that the headset did not cause eye strain or fatigue (4.5/5).”

4.5/5

“This technology allows for efficient and accurate registration of a patient's 3D anatomical model onto their head while positioned in the operating room.”

“Overall, the AR platform offers our neurosurgical team excellent visuospatial insights for preoperative decision-making.”

“We can utilize VR/AR technologies to identify patients that will benefit from an SOKC and expand the implementation of the approach beyond its current limitations.”

“Gross total resection and favorable functional outcome were finally achieved.”

“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 graphic performance was also deemed very satisfactory.”

“Through the combined use of routine 2D images and an interactive 3D anatomical model, an interhemispheric transtentorial approach was used to remove 98% of the lesion with successful functional outcomes.”

98%

“During the operation, we successfully identified the planned relationship between the aneurysm and the fetal PCA.”

“We have successfully created a valuable and easy-to-use neuroimaging data mixed reality app, laying the foundation for more future clinical uses, as more models and data derived from various biomedical images can be imported.”

“Modifications to 2-dimensional and "top-down" VR trajectory plans were made after "bottom-up" navigation in all cases.”

“Ultimately, surgical planning using virtual reality promotes both neurosurgical education and patient safety through clear visualization and understanding of different surgical approaches.”

“Excellent cosmetic results, decreased operative time, and a feasible workflow were achieved.”

“Because of the deep-seated location of this ICH, a patient-specific 360XR model rendered using Surgical Theater was used for preoperative planning and intraoperative navigation to allow for enhanced visualization and understanding of the pathology and surrounding anatomy.”

“Importantly, the interactive 360° VR model allowed for a detailed evaluation of the patient-specific anatomy prior to surgery and helped understand the complex anatomy in high resolution.”

“A preliminary qualitative evaluation revealed that holographic visualization of high-resolution 3D MRI data offers an intuitive and interactive perspective of the complex brain vasculature and anatomical structures.”

“SyncAR contributed positively to the 3D understanding of patient-specific anatomy and ability to operate.”

“Five patient procedures were rated as having an excellent correspondence degree, 5 had an adequate correspondence degree, and 1 had poor correspondence.”

“For two cases, the plan changed after reviewing the patient's 360°VR model from one based on conventional Digital Imaging and Communications in Medicine imaging.”

“Use of the 3D VR was used during preoperative planning allowing a better definition of surgical strategy.”

“MxR visualization allowed the operators to manipulate the dataset to achieve a greater understanding of the anatomy of the parent vessel, the angioarchitecture of the aneurysm, and the surface contours of all visualized structures.”

“Feedback from testing the prototype indicated potential for augmented reality to assist an interventionalist in spatial understanding and depth perception of spatially complex anatomy and could increase confidence in pre-procedural planning.”

“The AVM was safely resected using navigation integrated with VR; careful arterial devascularization preceded resection of the draining veins and then the AVM nidus.”

“Surgical planning in VR can be helpful to the early-career endoscopic surgeon.”

“The template enhanced the planning of the incision and soft-tissue exposure, guided the drilling of the sphenoid wing, facilitated the extradural clinoidectomy,5 and ultimately facilitated the accomplishment of the surgical goal of total resection of the meningioma.”

“Given the rarity of pineocytoma,5 the novelty of endoscopic resection of solid tumors in the region, and the challenge of "keyhole" approaches to deep-lying targets, VR rehearsal facilitated the achievement of the surgical goal and avoided the morbidity of a more extensive exposure.”

“Complete resections were achieved and neither patient suffered any approach-related complications.”

“Due to her progressive headache and visual deterioration, surgery was performed after comprehensive study in the Dextroscope system, details about the correlation among skull base, lesion, branches of internal carotid artery, and vessels inside the tumor were well demonstrated in this system.”

“VR visualization allowed the operators to manipulate the dataset to achieve a greater understanding of the anatomy of the parent vessel, the angioarchitecture of the pseudoaneurysm, and the surface contours of all visualized structures.”

“Holograms were successfully created in all cases.”