Preoperative Neurosurgical Planning Using Augmented and Virtual Reality Tools: A Team-Based Approach

Introduction: The use of advanced digital technologies neurosurgery has been an evolving field in the past 5 years. With the use of navigation assisted neurosurgery and now simulation integrated neurosurgery, the use of a team-based approach to preoperative planning has shown to be a highly useful step in the preoperative phase. Preoperative planning for a cranial based neurosurgical procedure requires diligent evaluation of the radiological scans including MRI, CT with and without angiography and sometimes MRV, MRA, angiogram.

The software allows us to fuse multiple high-volume sequences to create a 3D VR simulation of the patient’s anatomy. These high volume radiological sequences allows for a more detailed look at anatomical relationships.

Methods and Results: During preoperative planning, we employ cranial software for navigation and utilize the Smartbrush feature to create objects of interest. The Smartbrush tool is a computer-assisted paintbrush that allows the user to outline an area of interest or critical structure from the patients’ radiographic data.

These objects can then be uploaded into our navigation platform and used in a heads up display configuration with an intraoperative microscope. Here, the objects of interest are overlaid onto the patient's anatomy through the eyepieces in real time. Stereotactic navigation defines the coordinate frame for the microscope. The registration information may also be exported to a 3D simulation platform to help increase visualization and situational awareness during surgery. This technique is used for typical cranial surgical cases including resection of benign or malignant brain tumors, resection of vascular malformations, and clipping of aneurysms.

Conclusion: The virtual representation of the patient's data has changed the patient pipeline and surgical landscape. As this advanced technology becomes more available to neurosurgery departments across the country, specially trained surgical teams will be needed to link the technology platforms used in surgery and the operating physician.