ABSTRACT
Diversion of cerebrospinal fluid is required in many neurosurgical conditions. When a standard ventriculoperitoneal shunt and endoscopic third ventriculostomy are not appropriate options, placement of a ventriculoatrial shunt is a safe, relatively familiar second-line shunting procedure. Herein we reviewed the technical aspects of ventriculoatrial shunt placement using an illustrative case. We focused on the different modalities for inserting and confirming the location of the distal catheter tip. We discussed how to overcome typical difficulties and significant concerns, such as cardiac arrhythmias and venous thrombosis. In addition, we reviewed the current literature for the different complications associated with ventriculoatrial shunt placement.
Subject(s)
Cerebrospinal Fluid Shunts , Hydrocephalus , Catheters , Cerebrospinal Fluid Shunts/adverse effects , Cerebrospinal Fluid Shunts/methods , Humans , Hydrocephalus/surgery , Ventriculoperitoneal Shunt/adverse effects , Ventriculoperitoneal Shunt/methods , Ventriculostomy/adverse effectsABSTRACT
PURPOSE: Navigation systems commonly used in neurosurgery suffer from two main drawbacks: (1) their accuracy degrades over the course of the operation and (2) they require the surgeon to mentally map images from the monitor to the patient. In this paper, we introduce the Intraoperative Brain Imaging System (IBIS), an open-source image-guided neurosurgery research platform that implements a novel workflow where navigation accuracy is improved using tracked intraoperative ultrasound (iUS) and the visualization of navigation information is facilitated through the use of augmented reality (AR). METHODS: The IBIS platform allows a surgeon to capture tracked iUS images and use them to automatically update preoperative patient models and plans through fast GPU-based reconstruction and registration methods. Navigation, resection and iUS-based brain shift correction can all be performed using an AR view. IBIS has an intuitive graphical user interface for the calibration of a US probe, a surgical pointer as well as video devices used for AR (e.g., a surgical microscope). RESULTS: The components of IBIS have been validated in the laboratory and evaluated in the operating room. Image-to-patient registration accuracy is on the order of [Formula: see text] and can be improved with iUS to a median target registration error of 2.54 mm. The accuracy of the US probe calibration is between 0.49 and 0.82 mm. The average reprojection error of the AR system is [Formula: see text]. The system has been used in the operating room for various types of surgery, including brain tumor resection, vascular neurosurgery, spine surgery and DBS electrode implantation. CONCLUSIONS: The IBIS platform is a validated system that allows researchers to quickly bring the results of their work into the operating room for evaluation. It is the first open-source navigation system to provide a complete solution for AR visualization.
Subject(s)
Brain/surgery , Neuronavigation/methods , Neurosurgical Procedures/methods , Surgery, Computer-Assisted/methods , Brain/diagnostic imaging , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/surgery , Deep Brain Stimulation , Humans , Microsurgery , Operating Rooms , Prosthesis Implantation , Ultrasonography , User-Computer Interface , Vascular Surgical Procedures/methods , WorkflowABSTRACT
PURPOSE: The aim of this report is to present a prototype augmented reality (AR) intra-operative brain imaging system. We present our experience of using this new neuronavigation system in neurovascular surgery and discuss the feasibility of this technology for aneurysms, arteriovenous malformations (AVMs), and arteriovenous fistulae (AVFs). METHODS: We developed an augmented reality system that uses an external camera to capture the live view of the patient on the operating room table and to merge this view with pre-operative volume-rendered vessels. We have extensively tested the system in the laboratory and have used the system in four surgical cases: one aneurysm, two AVMs and one AVF case. RESULTS: The developed AR neuronavigation system allows for precise patient-to-image registration and calibration of the camera, resulting in a well-aligned augmented reality view. Initial results suggest that augmented reality is useful for tailoring craniotomies, localizing vessels of interest, and planning resection corridors. CONCLUSION: Augmented reality is a promising technology for neurovascular surgery. However, for more complex anomalies such as AVMs and AVFs, better visualization techniques that allow one to distinguish between arteries and veins and determine the absolute depth of a vessel of interest are needed.
Subject(s)
Arteriovenous Fistula/surgery , Intracranial Aneurysm/surgery , Intracranial Arteriovenous Malformations/surgery , Neuronavigation/methods , Adolescent , Cerebral Angiography , Craniotomy , Feasibility Studies , Female , Humans , Male , Middle Aged , Neurosurgical Procedures/methods , Operating Rooms , Tomography, X-Ray Computed , Vascular Surgical Procedures/methodsABSTRACT
In neurovascular surgery, and in particular surgery for arteriovenous malformations (AVMs), the surgeon maps pre-operative images to the patient on the operating table to aid in vessel localization and resection. This type of spatial mapping is not trivial, is time consuming, and may be prone to error. Using augmented reality (AR) we can register the microscope/camera image of the patient to pre-operative data in order to help the surgeon better understand the topology and locations of vessels that lie below the visible surface of the cortex. In this work we describe a prototype system, developed using open source software and built with off-the-shelf hardware, for AR visualization for AVM neurosurgery. Furthermore, we consider two visualization techniques, colour-coding and chromadepth, to enhance the depth perception of vessels.
