Surgery of the Cranio-Vertebral Junction: Image Guidance, Navigation, and Augmented Reality

Abstract

Due to the density of essential, small, and mobile structures, mastering the surgical anatomy of the craniovertebral junction may be extremely challenging. Quality and safety of interventions can be improved using navigation. Currently, patient-specific anatomy preparation, surgical planning, intervention, and quality assessment are disconnected actions performed in different conditions and environments and by multiple team members. The whole process needs to be integrated by surgeons performing the intervention. The complexity of the process exposes to errors and degraded precision. It is therefore relevant to develop tools that reduce the need to extrapolate and simplify the information integration and increase the ergonomics of its display.

Imaging information is acquired in the intervention setting to reduce extrapolation using intra-operative imaging. The current point-based registration process of the navigation devices using reference infrared or electromagnetic fiducials provides at best millimetric precision and lacks the ability to correct for anatomical deformations due to motion. It justifies direct optical accuracy check and registration correction comparing the adjustment of virtual reference objects segmented from anatomical studies and reality using augmented-reality displays. Once both the virtual environment and reality are perfectly synchronized, relevant target objects or structures at risk may be projected to the surgeon ergonomically using adapted augmented-reality displays. The whole system requires regular anatomical updates acquired using intra-operative imaging.

Modern integrated image-guided surgery assists young surgeons to learn procedures and masters to develop new techniques and better personalize, as well as customize each operation.