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Augmented reality in intradural spinal tumor surgery

  • Original Article - Spine - Other
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Abstract

Background

Microscope-based augmented reality (AR) is commonly used in cranial surgery; however, until recently, this technique was not implemented for spinal surgery. We prospectively investigated, how AR can be applied for intradural spinal tumor surgery.

Methods

For ten patients with intradural spinal tumors (ependymoma, glioma, hemangioblastoma, meningioma, and metastasis), AR was provided by head-up displays (HUDs) of operating microscopes. User-independent automatic AR registration was established by low-dose intraoperative computed tomography. The objects visualized by AR were segmented in preoperative imaging data; non-linear image registration was applied to consider spine flexibility.

Results

In all cases, AR supported surgery by visualizing the tumor outline and other relevant surrounding structures. The overall AR registration error was 0.72 ± 0.24 mm (mean ± standard deviation), a close matching of visible tumor outline and AR visualization was observed for all cases. Registration scanning resulted in a low effective dose of 0.22 ± 0.16 mSv for cervical and 1.68 ± 0.61 mSv for thoracic lesions. The mean HUD AR usage in relation to microscope time was 51.6 ± 36.7%. The HUD was switched off and turned on again in a range of 2 to 17 times (5.7 ± 4.4 times). Independent of the status of the HUD, the AR visualization was displayed on monitors throughout surgery.

Conclusions

Microscope-based AR can be reliably applied to intradural spinal tumor surgery. Automatic AR registration ensures high precision and provides an intuitive visualization of the extent of the tumor and surrounding structures. Given this setting, all advanced multi-modality options of cranial AR can also be applied to spinal surgery.

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Acknowledgments

We thank J.-W. Bartsch for proofreading the manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, University Marburg, Baldingerstrasse, 35033, Marburg, Germany

    Barbara Carl, Miriam Bopp, Benjamin Saß, Mirza Pojskic & Christopher Nimsky

  2. Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany

    Miriam Bopp & Christopher Nimsky

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  1. Barbara Carl
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Correspondence to Barbara Carl.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript, except that B. Carl and Ch. Nimsky have received speaker fees from Brainlab.

Ethical standards

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. We obtained ethics approval for prospective archiving clinical and technical data applying intraoperative imaging and navigation (study no. 99/18). Informed consent was obtained from all individual participants included in the study.

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Carl, B., Bopp, M., Saß, B. et al. Augmented reality in intradural spinal tumor surgery. Acta Neurochir 161, 2181–2193 (2019). https://doi.org/10.1007/s00701-019-04005-0

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