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Augmented reality navigation for cranial biopsy and external ventricular drain insertion

机译：用于颅脑活检和脑室外引流管插入的增强现实导航

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OBJECTIVE The aim of this study was to evaluate the accuracy (deviation from the target or intended path) and efficacy (insertion time) of an augmented reality surgical navigation (ARSN) system for insertion of biopsy needles and external ventricular drains (EVDs), two common neurosurgical procedures that require high precision. METHODS The hybrid operating room–based ARSN system, comprising a robotic C-arm with intraoperative cone-beam CT (CBCT) and integrated video tracking of the patient and instruments using nonobtrusive adhesive optical markers, was used. A 3D-printed skull phantom with a realistic gelatinous brain model containing air-filled ventricles and 2-mm spherical biopsy targets was obtained. After initial CBCT acquisition for target registration and planning, ARSN was used for 30 cranial biopsies and 10 EVD insertions. Needle positions were verified by CBCT. RESULTS The mean accuracy of the biopsy needle insertions (n = 30) was 0.8 mm ± 0.43 mm. The median path length was 39 mm (range 16–104 mm) and did not correlate to accuracy (p = 0.15). The median device insertion time was 149 seconds (range 87–233 seconds). The mean accuracy for the EVD insertions (n = 10) was 2.9 mm ± 0.8 mm at the tip with a 0.7° ± 0.5° angular deviation compared with the planned path, and the median insertion time was 188 seconds (range 135–400 seconds). CONCLUSIONS This study demonstrated that ARSN can be used for navigation of percutaneous cranial biopsies and EVDs with high accuracy and efficacy.
机译：目的 本研究的目的是评估增强现实手术导航 （ARSN） 系统插入活检针和脑室外引流管 （EVD） 的准确性（与目标或预期路径的偏差）和有效性（插入时间），这两种常见的神经外科手术需要高精度。方法 使用基于混合手术室的 ARSN 系统，包括带有术中锥形束 CT （CBCT） 的机器人 C 臂和使用非侵入性粘性光学标记对患者和器械进行集成视频跟踪。获得了一个 3D 打印的头骨模型，该模型具有逼真的凝胶状大脑模型，其中包含充满空气的心室和 2 毫米球形活检目标。在最初采集CBCT进行靶点登记和规划后，ARSN用于30例颅脑活检和10例埃博拉病毒病植入。针头位置通过CBCT验证。结果 活检针插入的平均准确度 （n = 30） 为 0.8 mm ± 0.43 mm。中值光程长度为 39 mm（范围 16–104 mm），与精度无关 （p = 0.15）。中位器械插入时间为 149 秒（范围为 87-233 秒）。与计划路径相比，EVD 插入的平均精度 （n = 10） 为 2.9 mm ± 0.8 mm，角偏差为 0.7° ± 0.5°，中位插入时间为 188 秒（范围为 135–400 秒）。结论 ARSN可用于经皮颅脑活检和埃博拉病毒病的导航，具有较高的准确性和有效性。

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