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J Neurol Surg B Skull Base 2022; 83(S 02): e564-e573
DOI: 10.1055/s-0041-1735509
Original Article

Augmented Reality for Retrosigmoid Craniotomy Planning

Christoph Leuze  ‡   *
1   Department of Radiology, Stanford School of Medicine, Stanford, United States
,
Caio A. Neves‡   *
2   Department of Otolaryngology, Stanford School of Medicine, Stanford, United States
3   Faculty of Medicine, University of Brasília, Brasília, Brazil
,
Alejandro M. Gomez
4   Chair for Computer Aided Medical Procedures and Augmented Reality, Department of Informatics, Technical University of Munich, Germany
5   Laboratory for Computer Aided Medical Procedures, Whiting School of Engineering, Johns Hopkins University, Baltimore, United States
,
Nassir Navab
4   Chair for Computer Aided Medical Procedures and Augmented Reality, Department of Informatics, Technical University of Munich, Germany
5   Laboratory for Computer Aided Medical Procedures, Whiting School of Engineering, Johns Hopkins University, Baltimore, United States
,
Nikolas Blevins
2   Department of Otolaryngology, Stanford School of Medicine, Stanford, United States
,
Yona Vaisbuch
2   Department of Otolaryngology, Stanford School of Medicine, Stanford, United States
,
Jennifer A. McNab
1   Department of Radiology, Stanford School of Medicine, Stanford, United States
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Abstract

While medical imaging data have traditionally been viewed on two-dimensional (2D) displays, augmented reality (AR) allows physicians to project the medical imaging data on patient's bodies to locate important anatomy. We present a surgical AR application to plan the retrosigmoid craniotomy, a standard approach to access the posterior fossa and the internal auditory canal. As a simple and accurate alternative to surface landmarks and conventional surgical navigation systems, our AR application augments the surgeon's vision to guide the optimal location of cortical bone removal. In this work, two surgeons performed a retrosigmoid approach 14 times on eight cadaver heads. In each case, the surgeon manually aligned a computed tomography (CT)-derived virtual rendering of the sigmoid sinus on the real cadaveric heads using a see-through AR display, allowing the surgeon to plan and perform the craniotomy accordingly. Postprocedure CT scans were acquired to assess the accuracy of the retrosigmoid craniotomies with respect to their intended location relative to the dural sinuses. The two surgeons had a mean margin of davg = 0.6 ± 4.7 mm and davg = 3.7 ± 2.3 mm between the osteotomy border and the dural sinuses over all their cases, respectively, and only positive margins for 12 of the 14 cases. The intended surgical approach to the internal auditory canal was successfully achieved in all cases using the proposed method, and the relatively small and consistent margins suggest that our system has the potential to be a valuable tool to facilitate planning a variety of similar skull-base procedures.

Keywords

augmented reality - craniotomy - retrosigmoid approach - acoustic neuroma - schwannoma - magicleap

* These authors contributed equally.




Publication History

Received: 04 December 2020

Accepted: 28 July 2021

Article published online:
10 September 2021

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