![]() ![]() Further studies are being planned to assess its accuracy and suitability across various surgical disciplines. (3) Conclusion: Although certain limitations were identified, the authors feel that this system is a feasible alternative device for intra-operative visualization of neurosurgical pathology. Registration in prone position with a conventional neuronavigation system is often difficult, which was easily overcome during use of HoloLens 2. The process of image overlay was relatively straightforward for the three cases. Surgeon training and usage for HoloLens 2 was short and easy. We evaluated surgeon experience, accuracy of superimposed 3D image in tumour localisation with standard neuronavigation both pre- and intra-operatively. (2) Results: We describe our experience with three patients who underwent tumour resection. We present our experience using the HoloLens 2 in neuro-oncology for both intra- and extra-axial tumours. Recent progress in mixed reality (MR) technology has attempted to overcome the disadvantages of the neuronavigation systems. (1) Background: Intra-operative neuronavigation is currently an essential component to most neurosurgical operations. The extended navigation pointer lines touch the medial (M) and lateral (N) boundary of the lesion. M and N: The “inline 2” navigation mode is chosen. Its extended lines touch the anterior (K) and posterior (L) boundary of the lesion. K and L: On the SN monitor, the “inline 1” navigation mode is chosen the thick green line indicates the navigation probe which is vertical to the head surface. I and J: The operator points the navigation probe to the medial boundary of the lesion. The probe direction is adjusted to be parallel with the sagittal plane and vertical to the midsagittal line. G and H: After coregistration with the navigation system, the operator points the navigation pointer (Brainlab AG) to the anterior boundary of the lesion. E and F: Measurement of the medial (E) and anterior (F) deviation between MRN (the boundary of the green hologram) and SN (black dashes). D: Registration procedure by the neurosurgeon with the HMD. C: Registration sockets attached to the patient’s head at the same locus after scanning and anesthesia. B: Registration markers attached to the patient’s head before scanning. A: Axial preoperative MR image obtained in a 51-year-old man with a right occipital lesion. Holographic lesion localization procedures and comparison with an SN system. Further development is required to improve the accuracy and clinical efficacy of this system. This study provided a complete set of a clinically applicable workflow on an easy-to-use MRN system using a wearable HMD, and has shown its technical feasibility and accuracy. There was no significant difference in additional operating time between different operators (37.4 ± 4.8 minutes vs 34.6 ± 4.8 minutes, p = 0.237) or in localization deviation (3.7 ± 1.0 mm vs 4.6 ± 1.5 mm, p = 0.070). The magnitudes of deviation vectors did not correlate with lesion volume (p = 0.126) or depth (p = 0.128). There was a significant difference between the supine position and the prone position (3.7 ± 1.1 mm vs 5.4 ± 0.9 mm, p = 0.001). The overall median deviation was 4.1 mm (IQR 3.0 mm-4.7 mm), and 81.1% of the lesions localized by MRN were found to be highly consistent with SN (deviation < 5.0 mm). A trend toward a shorter time required for preparation was observed with the increase of neurosurgeon experience with the MRN system. The mean additional time required for MRN was 36.3 ± 6.3 minutes, in which the mean registration time was 2.6 ± 0.9 minutes. MRN localization was achieved in all patients. The distance between the two contours generated by MRN and SN was measured so that the accuracy of MRN could be assessed. The projection of the lesion boundaries perceived by the neurosurgeon on the patient's scalp was then marked with MRN and SN. The contour of the holograms was compared with standard neuronavigation (SN). After a point-based registration, the holograms were projected onto the patient's head and observed through the HMD. ![]() For each patient, multimodal imaging-based holograms of lesions, markers, and surrounding eloquent structures were created and then imported to the MRN HMD. ![]() Thirty-seven patients with intracranial lesions were prospectively identified. The authors aimed to evaluate the technical feasibility of a mixed-reality neuronavigation (MRN) system with a wearable head-mounted device (HMD) and to determine its clinical application and accuracy.Ī semiautomatic registration MRN system on HoloLens smart glasses was developed and tested for accuracy and feasibility. ![]()
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