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Medicina
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Clinical Application of Augmented Reality (AR) in Neurosurgery
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Clinical Application of Augmented Reality (AR) in Neurosurgery

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Neurology".

Deadline for manuscript submissions: 30 April 2024 | Viewed by 8206

Special Issue Editors

Dr. Ibrahim E. Efe

E-Mail Website
Guest Editor
Department of Neurosurgery, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
Interests: skull base surgery; glioma immunotherapy; robotics; extended reality
Dr. Markus Holling

E-Mail Website
Guest Editor
Department of Neurosurgery, University Hospital Münster, Münster, Germany
Interests: extended reality; neurosurgery education; cerebrovascular pathologies

Special Issue Information

Dear Colleagues,

Extended reality (XR) technologies have gained increasing attention in medical research in recent years. For example, augmented reality (AR) has allowed us to overcome the limitations of standard two-dimensional imaging by superimposing virtual objects onto the user’s view of the real world. This has opened the way for various applications ranging from education and training to preoperative planning and intraoperative use. One of the specialties most heavily reliant on sophisticated imaging, neurosurgery, was among the early adopters of AR and has been at the forefront of research and development related to this technology. However, despite its burgeoning role in modern neurosurgery, AR is frequently met with hesitance among clinicians due to several technical challenges. Thus, much work remains to be carried out for its seamless integration into the neurosurgeon’s workflow and for its full potential to be realized.

This Special Issue will serve as a collection of original research articles, systematic and narrative reviews, and opinion pieces on clinical applications of AR in neurosurgery, as well as current challenges and prospects that should be addressed in the context of this technology. 

Specific themes may include but are not limited to:

  • AR-assisted preoperative planning;
  • AR-assisted multimodal neuronavigation;
  • Intraoperative use of AR in cranial and spinal neurosurgery;
  • AR-assisted patient education and informed consent;
  • AR-assisted neuroanatomy education;
  • Simulation and training using AR;
  • Use of microscope-mediated heads-up displays and head-mounted displays in the neurosurgical operating theater.

We very much look forward to your contributions.

Dr. Ibrahim E. Efe
Dr. Markus Holling
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • augmented reality
  • AR
  • extended reality
  • XR
  • neurosurgery
  • spine surgery
  • education
  • training
  • preoperative planning

Published Papers (5 papers)

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Research

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15 pages, 1266 KiB  
Article
Utilization of Augmented Reality Head-Mounted Display for the Surgical Management of Thoracolumbar Spinal Trauma
by Michael Ryan Kann, Miguel A. Ruiz-Cardozo, Samuel Brehm, Tim Bui, Karan Joseph, Karma Barot, Gabriel Trevino, Abigail Carey-Ewend, Som P. Singh, Matthew De La Paz, Ahmed Hanafy, Michael Olufawo, Rujvee P. Patel, Alexander T. Yahanda, Alexander Perdomo-Pantoja, Julio J. Jauregui, Magalie Cadieux, Brenton Pennicooke and Camilo A. Molina
Medicina 2024, 60(2), 281; https://doi.org/10.3390/medicina60020281 - 06 Feb 2024
Viewed by 863
Abstract
Background and Objectives: Augmented reality head-mounted display (AR-HMD) is a novel technology that provides surgeons with a real-time CT-guided 3-dimensional recapitulation of a patient’s spinal anatomy. In this case series, we explore the use of AR-HMD alongside more traditional robotic assistance in [...] Read more.
Background and Objectives: Augmented reality head-mounted display (AR-HMD) is a novel technology that provides surgeons with a real-time CT-guided 3-dimensional recapitulation of a patient’s spinal anatomy. In this case series, we explore the use of AR-HMD alongside more traditional robotic assistance in surgical spine trauma cases to determine their effect on operative costs and perioperative outcomes. Materials and Methods: We retrospectively reviewed trauma patients who underwent pedicle screw placement surgery guided by AR-HMD or robotic-assisted platforms at an academic tertiary care center between 1 January 2021 and 31 December 2022. Outcome distributions were compared using the Mann–Whitney U test. Results: The AR cohort (n = 9) had a mean age of 66 years, BMI of 29.4 kg/m2, Charlson Comorbidity Index (CCI) of 4.1, and Surgical Invasiveness Index (SII) of 8.8. In total, 77 pedicle screws were placed in this cohort. Intra-operatively, there was a mean blood loss of 378 mL, 0.78 units transfused, 398 min spent in the operating room, and a 20-day LOS. The robotic cohort (n = 13) had a mean age of 56 years, BMI of 27.1 kg/m2, CCI of 3.8, and SII of 14.2. In total, 128 pedicle screws were placed in this cohort. Intra-operatively, there was a mean blood loss of 432 mL, 0.46 units transfused units used, 331 min spent in the operating room, and a 10.4-day LOS. No significant difference was found between the two cohorts in any outcome metrics. Conclusions: Although the need to address urgent spinal conditions poses a significant challenge to the implementation of innovative technologies in spine surgery, this study represents an initial effort to show that AR-HMD can yield comparable outcomes to traditional robotic surgical techniques. Moreover, it highlights the potential for AR-HMD to be readily integrated into Level 1 trauma centers without requiring extensive modifications or adjustments. Full article
(This article belongs to the Special Issue Clinical Application of Augmented Reality (AR) in Neurosurgery)
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12 pages, 2714 KiB  
Article
Neurosurgical Education Using Cadaver-Free Brain Models and Augmented Reality: First Experiences from a Hands-On Simulation Course for Medical Students
by Ibrahim E. Efe, Emre Çinkaya, Leonard D. Kuhrt, Melanie M. T. Bruesseler and Armin Mührer-Osmanagic
Medicina 2023, 59(10), 1791; https://doi.org/10.3390/medicina59101791 - 09 Oct 2023
Cited by 2 | Viewed by 1420
Abstract
Background and Objectives: Neurosurgery has been underrepresented in the medical school curriculum. Advances in augmented reality and 3D printing have opened the way for early practical training through simulations. We assessed the usability of the UpSurgeOn simulation-based training model and report first [...] Read more.
Background and Objectives: Neurosurgery has been underrepresented in the medical school curriculum. Advances in augmented reality and 3D printing have opened the way for early practical training through simulations. We assessed the usability of the UpSurgeOn simulation-based training model and report first experiences from a hands-on neurosurgery course for medical students. Materials and Methods: We organized a two-day microneurosurgery simulation course tailored to medical students. On day one, three neurosurgeons demonstrated anatomical explorations with the help of life-like physical simulators (BrainBox, UpSurgeOn). The surgical field was projected onto large high-definition screens by a robotic-assisted exoscope (RoboticScope, BHS Technologies). On day two, the students were equipped with microsurgical instruments to explore the surgical anatomy of the pterional, temporal and endoscopic retrosigmoid approaches. With the help of the RoboticScope, they simulated five clipping procedures using the Aneurysm BrainBox. All medical students filled out a digital Likert-scale-based questionnaire to evaluate their experiences. Results: Sixteen medical students participated in the course. No medical students had previous experience with UpSurgeOn. All participants agreed that the app helped develop anatomical orientation. They unanimously agreed that this model should be part of residency training. Fourteen out of sixteen students felt that the course solidified their decision to pursue neurosurgery. The same fourteen students rated their learning experience as totally positive, and the remaining two rated it as rather positive. Conclusions: The UpSurgeOn educational app and cadaver-free models were perceived as usable and effective tools for the hands-on neuroanatomy and neurosurgery teaching of medical students. Comparative studies may help measure the long-term benefits of UpSurgeOn-assisted teaching over conventional resources. Full article
(This article belongs to the Special Issue Clinical Application of Augmented Reality (AR) in Neurosurgery)
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10 pages, 2142 KiB  
Article
Mixed Reality as a Teaching Tool for Medical Students in Neurosurgery
by Arturo Silvero Isidre, Hendrik Friederichs, Michael Müther, Marco Gallus, Walter Stummer and Markus Holling
Medicina 2023, 59(10), 1720; https://doi.org/10.3390/medicina59101720 - 26 Sep 2023
Cited by 1 | Viewed by 1193
Abstract
Background and Objectives: Simulation-based learning within neurosurgery provides valuable and realistic educational experiences in a safe environment, enhancing the current teaching model. Mixed reality (MR) simulation can deliver a highly immersive experience through head-mounted displays and has become one of the most [...] Read more.
Background and Objectives: Simulation-based learning within neurosurgery provides valuable and realistic educational experiences in a safe environment, enhancing the current teaching model. Mixed reality (MR) simulation can deliver a highly immersive experience through head-mounted displays and has become one of the most promising teaching tools in medical education. We aimed to identify whether an MR neurosurgical simulation module within the setting of an undergraduate neurosurgical hands-on course could improve the satisfaction of medical students. Materials and Methods: The quasi-experimental study with 223 medical students [120 in the conventional group (CG) and 103 in the MR-group (MRG)] was conducted at the University Hospital Münster, Münster, Germany. An MR simulation module was presented to the intervention group during an undergraduate neurosurgical hands-on course. Images of a skull fracture were reconstructed into 3D formats compatible with the MR-Viewer (Brainlab, Munich, Germany). Participants could interact virtually with the model and plan a surgical strategy using Magic Leap goggles. The experience was assessed by rating the course on a visual analog scale ranging from 1 (very poor) to 100 (very good) and an additional Likert-scale questionnaire. Results: The satisfaction score for CG and MRG were 89.3 ± 13.3 and 94.2 ± 7.5, respectively. The Wilcoxon rank-sum test showed that MR users (Mdn = 97.0, IQR = 4, n = 103) were significantly more satisfied than CG users (Mdn = 93.0, IQR = 10, n = 120; ln(W) = 8.99, p < 0.001) with moderate effect size (r^biserial = 0.30, CI95 [0.15, 0.43]), thus indicating that the utilization of MR-simulation is associated with greater satisfaction. Conclusions: This study reports a positive response from medical students towards MR as an educational tool. Feedback from the medical students encourages the adoption of disruptive technologies into medical school curricula. Full article
(This article belongs to the Special Issue Clinical Application of Augmented Reality (AR) in Neurosurgery)
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Review

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16 pages, 1031 KiB  
Review
Augmented Reality in Neurosurgery: A New Paradigm for Training
by Grace Hey, Michael Guyot, Ashley Carter and Brandon Lucke-Wold
Medicina 2023, 59(10), 1721; https://doi.org/10.3390/medicina59101721 - 26 Sep 2023
Cited by 8 | Viewed by 2420
Abstract
Augmented reality (AR) involves the overlay of computer-generated images onto the user’s real-world visual field to modify or enhance the user’s visual experience. With respect to neurosurgery, AR integrates preoperative and intraoperative imaging data to create an enriched surgical experience that has been [...] Read more.
Augmented reality (AR) involves the overlay of computer-generated images onto the user’s real-world visual field to modify or enhance the user’s visual experience. With respect to neurosurgery, AR integrates preoperative and intraoperative imaging data to create an enriched surgical experience that has been shown to improve surgical planning, refine neuronavigation, and reduce operation time. In addition, AR has the potential to serve as a valuable training tool for neurosurgeons in a way that minimizes patient risk while facilitating comprehensive training opportunities. The increased use of AR in neurosurgery over the past decade has led to innovative research endeavors aiming to develop novel, more efficient AR systems while also improving and refining present ones. In this review, we provide a concise overview of AR, detail current and emerging uses of AR in neurosurgery and neurosurgical training, discuss the limitations of AR, and provide future research directions. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 386 articles were initially identified. Two independent reviewers (GH and AC) assessed article eligibility for inclusion, and 31 articles are included in this review. The literature search included original (retrospective and prospective) articles and case reports published in English between 2013 and 2023. AR assistance has shown promise within neuro-oncology, spinal neurosurgery, neurovascular surgery, skull-base surgery, and pediatric neurosurgery. Intraoperative use of AR was found to primarily assist with surgical planning and neuronavigation. Similarly, AR assistance for neurosurgical training focused primarily on surgical planning and neuronavigation. However, studies included in this review utilize small sample sizes and remain largely in the preliminary phase. Thus, future research must be conducted to further refine AR systems before widespread intraoperative and educational use. Full article
(This article belongs to the Special Issue Clinical Application of Augmented Reality (AR) in Neurosurgery)
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Other

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32 pages, 2577 KiB  
Systematic Review
Virtual, Augmented, and Mixed Reality Applications for Surgical Rehearsal, Operative Execution, and Patient Education in Spine Surgery: A Scoping Review
by Tim Bui, Miguel A. Ruiz-Cardozo, Harsh S. Dave, Karma Barot, Michael Ryan Kann, Karan Joseph, Sofia Lopez-Alviar, Gabriel Trevino, Samuel Brehm, Alexander T. Yahanda and Camilo A Molina
Medicina 2024, 60(2), 332; https://doi.org/10.3390/medicina60020332 - 15 Feb 2024
Viewed by 1453
Abstract
Background and Objectives: Advances in virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies have resulted in their increased application across many medical specialties. VR’s main application has been for teaching and preparatory roles, while AR has been mostly used [...] Read more.
Background and Objectives: Advances in virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies have resulted in their increased application across many medical specialties. VR’s main application has been for teaching and preparatory roles, while AR has been mostly used as a surgical adjunct. The objective of this study is to discuss the various applications and prospects for VR, AR, and MR specifically as they relate to spine surgery. Materials and Methods: A systematic review was conducted to examine the current applications of VR, AR, and MR with a focus on spine surgery. A literature search of two electronic databases (PubMed and Scopus) was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The study quality was assessed using the MERSQI score for educational research studies, QUACS for cadaveric studies, and the JBI critical appraisal tools for clinical studies. Results: A total of 228 articles were identified in the primary literature review. Following title/abstract screening and full-text review, 46 articles were included in the review. These articles comprised nine studies performed in artificial models, nine cadaveric studies, four clinical case studies, nineteen clinical case series, one clinical case–control study, and four clinical parallel control studies. Teaching applications utilizing holographic overlays are the most intensively studied aspect of AR/VR; the most simulated surgical procedure is pedicle screw placement. Conclusions: VR provides a reproducible and robust medium for surgical training through surgical simulations and for patient education through various platforms. Existing AR/MR platforms enhance the accuracy and precision of spine surgeries and show promise as a surgical adjunct. Full article
(This article belongs to the Special Issue Clinical Application of Augmented Reality (AR) in Neurosurgery)
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