Mini-Pterional Craniotomy and Extradural Clinoidectomy for Clinoid Meningioma: Optimization of Exposure Using Augmented Reality Template: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Walter C Jean
Keyword(s):  
Augmented Reality ◽  
Paradigm Shift ◽  
Patient Specific ◽  
Pterional Approach ◽  
3 Dimensional ◽  
Novel Technology ◽  
Patient Consent ◽  
Keyhole Approach ◽  
Base Lesion ◽  
Daunting Challenge

Abstract A “keyhole” approach to a deep-lying skull base lesion, as such a clinoid meningioma, can be a daunting challenge.1-3 The minimally invasive exposure must be precisely placed and adequately wide to accomplish the surgical goal. Surgical rehearsal in virtual reality (VR) can not only increase the confidence of the surgeon through practice on patient-specific anatomy,4 but it can also generate navigation-integrated templates to ensure precise placement and adequate bone openings. In this operative video, we demonstrate the use of an augmented reality (AR) template in a 69-yr-old woman with a growing clinoid meningioma. The 3-dimensional, VR rendering (SNAP VR360, Surgical Theater Inc, Cleveland, Ohio) of her right clinoid meningioma was used in surgical rehearsal for the mini-pterional approach with extradural clinoidectomy. The optimal opening was saved as a VR file and, at surgery, projected into the eye-piece of the navigation-tracked microscope (Synchronized AR v3.8.0, Surgical Theater Inc). In this manner, the surgical opening in the template was visible in AR on the patient's anatomy in real time during surgery. The template enhanced the planning of the incision and soft-tissue exposure, guided the drilling of the sphenoid wing, facilitated the extradural clinoidectomy,5 and ultimately facilitated the accomplishment of the surgical goal of total resection of the meningioma. With this application of novel technology, the surgeon is no longer using navigation to get her/his bearings. Instead, the surgeon is using AR-enhanced navigation to duplicate a plan that is known to work. This is a fundamental paradigm shift.  Patient consent was obtained prior to the creation of the video and is available on request.

scholarly journals Augmented-reality template guided transorbital approach for intradural tumors

2022 ◽  
Vol 6 (1) ◽  
pp. V3
Keyword(s):  
Virtual Reality ◽  
Soft Tissue ◽  
Augmented Reality ◽  
Minimally Invasive ◽  
Skull Base ◽  
Patient Specific ◽  
Link Type ◽  
Base Lesion

For “minimally invasive” approaches to a deep-lying skull base lesion, the bone opening must be precisely placed and adequately wide to accomplish the surgical goal. Surgical rehearsal in virtual reality (VR) can generate navigation-integrated augmented reality (AR) templates to ensure precise surgical openings. In this video, the authors used AR templates for the transpalpebral, transorbital approach for intradural tumors. VR renderings of patient-specific anatomy were used in surgical rehearsal. The optimal openings were saved and, at surgery, projected into the eyepiece of the navigation-tracked microscope. The template enhanced the planning of the incision and soft-tissue exposure and guided the drill toward the target. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21172

scholarly journals Augmented reality in the operating room: a clinical feasibility study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Cyrill Dennler ◽  
David E. Bauer ◽  
Anne-Gita Scheibler ◽  
José Spirig ◽  
Tobias Götschi ◽  
...  
Keyword(s):  
Image Quality ◽  
Augmented Reality ◽  
Orthopedic Surgery ◽  
Low Cost ◽  
Three Dimensional ◽  
Patient Specific ◽  
Navigation Systems ◽  
Novel Technology ◽  
Orthopedic Surgeons ◽  
Orthopedic Surgical Procedures

Abstract Background Augmented Reality (AR) is a rapidly emerging technology finding growing acceptance and application in different fields of surgery. Various studies have been performed evaluating the precision and accuracy of AR guided navigation. This study investigates the feasibility of a commercially available AR head mounted device during orthopedic surgery. Methods Thirteen orthopedic surgeons from a Swiss university clinic performed 25 orthopedic surgical procedures wearing a holographic AR headset (HoloLens, Microsoft, Redmond, WA, USA) providing complementary three-dimensional, patient specific anatomic information. The surgeon’s experience of using the device during surgery was recorded using a standardized 58-item questionnaire grading different aspects on a 100-point scale with anchor statements. Results Surgeons were generally satisfied with image quality (85 ± 17 points) and accuracy of the virtual objects (84 ± 19 point). Wearing the AR device was rated as fairly comfortable (79 ± 13 points). Functionality of voice commands (68 ± 20 points) and gestures (66 ± 20 points) provided less favorable results. The greatest potential in the use of the AR device was found for surgical correction of deformities (87 ± 15 points). Overall, surgeons were satisfied with the application of this novel technology (78 ± 20 points) and future access to it was demanded (75 ± 22 points). Conclusion AR is a rapidly evolving technology with large potential in different surgical settings, offering the opportunity to provide a compact, low cost alternative requiring a minimum of infrastructure compared to conventional navigation systems. While surgeons where generally satisfied with image quality of the here tested head mounted AR device, some technical and ergonomic shortcomings were pointed out. This study serves as a proof of concept for the use of an AR head mounted device in a real-world sterile setting in orthopedic surgery.

Cervical 1-2 Posterior Instrumented Fusion Utilizing Computer-Assisted Navigation With Harvest of Rib Strut Autograft: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Timothy J Yee ◽  
Michael J Strong ◽  
Matthew S Willsey ◽  
Mark E Oppenlander
Keyword(s):  
Surface Area ◽  
Odontoid Process ◽  
Odontoid Fracture ◽  
Patient Specific ◽  
Computer Assisted ◽  
Type Ii ◽  
Instrumented Fusion ◽  
Assisted Navigation ◽  
Patient Consent ◽  
Posterior Instrumented Fusion

Abstract Nonunion of a type II odontoid fracture after the placement of an anterior odontoid screw can occur despite careful patient selection. Countervailing factors to successful fusion include the vascular watershed zone between the odontoid process and body of C2 as well as the relatively low surface area available for fusion. Patient-specific factors include osteoporosis, advanced age, and poor fracture fragment apposition. Cervical 1-2 posterior instrumented fusion is indicated for symptomatic nonunion. The technique leverages the larger posterolateral surface area for fusion and does not rely on bony growth in a watershed zone. Although loss of up to half of cervical rotation is expected after C1-2 arthrodesis, this may be better tolerated in the elderly, who may have lower physical demands than younger patients. In this video, we discuss the case of a 75-yr-old woman presenting with intractable mechanical cervicalgia 7 mo after sustaining a type II odontoid fracture and undergoing anterior odontoid screw placement at an outside institution. Cervical radiography and computed tomography exhibited haloing around the screw and nonunion across the fracture. We demonstrate C1-2 posterior instrumented fusion with Goel-Harms technique (C1 lateral mass and C2 pedicle screws), utilizing computer-assisted navigation, and modified Sonntag technique with rib strut autograft.  Posterior C1-2-instrumented fusion with rib strut autograft is an essential technique in the spine surgeon's armamentarium for the management of C1-2 instability, which can be a sequela of type II dens fracture. Detailed video demonstration has not been published to date.  Appropriate patient consent was obtained.

Thrombectomy and Clip Occlusion of a Giant, Stent-Coiled Basilar Bifurcation Aneurysm: 3-Dimensional Operative Video

2021 ◽  
Author(s):  
Fabio A Frisoli ◽  
Joshua S Catapano ◽  
S Harrison Farber ◽  
Jacob F Baranoski ◽  
Rohin Singh ◽  
...  
Keyword(s):  
Circulatory Arrest ◽  
Ventricular Pacing ◽  
Indocyanine Green Videoangiography ◽  
Aneurysm Neck ◽  
3 Dimensional ◽  
Bifurcation Aneurysm ◽  
Patient Consent ◽  
Rapid Ventricular Pacing ◽  
Proximal Occlusion ◽  
Clip Occlusion

Abstract Giant basilar apex aneurysms are associated with significant therapeutic challenges.1–6 Multiple techniques exist to treat giant basilar apex aneurysms, including direct clipping, stent-assisted coil embolization, and proximal occlusion with bypass revascularization.7–9 Hypothermic circulatory arrest was a useful adjunct for surgical repair of these aneurysms but has been abandoned because of associated risks.10,11 Rapid ventricular pacing can achieve similar aneurysm softening with minimal risks and assist in clip occlusion. This case illustrates clip occlusion of a giant, partially thrombosed, previously stent-coiled basilar apex aneurysm in a 15-yr-old boy with progressive cranial neuropathies and sensorimotor impairment. Although a wire was placed preoperatively for ventricular pacing, it was not needed during the procedure. Patient consent was obtained. A right-sided orbitozygomatic craniotomy transcavernous approach with anterior and posterior clinoidectomies was performed. The basilar quadrification was dissected, and proximal control was obtained. After aneurysm trapping, the aneurysm was incised and thrombectomized using an ultrasonic aspirator. Back-bleeding from the aneurysm was anticipated, and ventricular pacing was ready, but back-bleeding was minimal. With the coil mass left in place, stacked, fenestrated clips were applied in a tandem fashion to occlude the aneurysm neck. Indocyanine green videoangiography confirmed occlusion of the aneurysm and patency of parent and branch arteries. The patient was at a neurological baseline after the operation, with improvement in motor skills and cognition at 3-mo follow-up. This case demonstrates the use of trans-sylvian-transcavernous exposure, rapid ventricular pacing, and thrombectomy amid previous coils and stents to clip a giant, thrombotic basilar apex aneurysm. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Automatic 3D augmented reality RAPN with Indocyanine green guidance: A novel technology for a more precise surgical resection

2021 ◽  
Vol 79 ◽  
pp. S805-S806
Author(s):  
F. Porpiglia ◽  
D. Amparore ◽  
F. Piramide ◽  
E. Checcucci ◽  
P. Verri ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Indocyanine Green ◽  
Surgical Resection ◽  
Novel Technology

scholarly journals Hybrid Spine Simulator Prototype for X-ray Free Pedicle Screws Fixation Training

2021 ◽  
Vol 11 (3) ◽  
pp. 1038
Author(s):  
Sara Condino ◽  
Giuseppe Turini ◽  
Virginia Mamone ◽  
Paolo Domenico Parchi ◽  
Vincenzo Ferrari
Keyword(s):  
Augmented Reality ◽  
Low Cost ◽  
Lumbar Vertebrae ◽  
Pedicle Screws ◽  
Simulation Software ◽  
Patient Specific ◽  
Innovative Strategy ◽  
X Ray ◽  
3D Printed ◽  
Harmful Radiation

Simulation for surgical training is increasingly being considered a valuable addition to traditional teaching methods. 3D-printed physical simulators can be used for preoperative planning and rehearsal in spine surgery to improve surgical workflows and postoperative patient outcomes. This paper proposes an innovative strategy to build a hybrid simulation platform for training of pedicle screws fixation: the proposed method combines 3D-printed patient-specific spine models with augmented reality functionalities and virtual X-ray visualization, thus avoiding any exposure to harmful radiation during the simulation. Software functionalities are implemented by using a low-cost tracking strategy based on fiducial marker detection. Quantitative tests demonstrate the accuracy of the method to track the vertebral model and surgical tools, and to coherently visualize them in either the augmented reality or virtual fluoroscopic modalities. The obtained results encourage further research and clinical validation towards the use of the simulator as an effective tool for training in pedicle screws insertion in lumbar vertebrae.

Variation in femoral anteversion in patients requiring total hip replacement

2019 ◽  
Vol 30 (3) ◽  
pp. 281-287
Author(s):  
Jim W Pierrepont ◽  
Ed Marel ◽  
Jonathan V Baré ◽  
Leonard R Walter ◽  
Catherine Z Stambouzou ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Femoral Stem ◽  
Femoral Anteversion ◽  
Patient Specific ◽  
3 Dimensional ◽  
Total Hip ◽  
Age Related ◽  
Gender And Age ◽  
Implant Alignment

Background: Optimal implant alignment is important for total hip replacement (THR) longevity. Femoral stem anteversion is influenced by the native femoral anteversion. Knowing a patient’s femoral morphology is therefore important when planning optimal THR alignment. We investigated variation in femoral anteversion across a patient population requiring THR. Methods: Preoperatively, native femoral neck anteversion was measured from 3-dimensional CT reconstructions in 1215 patients. Results: The median femoral anteversion was 14.4° (−27.1–54.5°, IQR 7.4–20.9°). There were significant gender differences (males 12.7°, females 16.0°; p < 0.0001). Femoral anteversion in males decreased significantly with increasing age. 14% of patients had extreme anteversion (<0° or >30°). Conclusions: This is the largest series investigating native femoral anteversion in a THR population. Patient variation was large and was similar to published findings of a non-THR population. Gender and age-related differences were observed. Native femoral anteversion is patient-specific and should be considered when planning THR.

scholarly journals PENGEMBANGAN APLIKASI AUGMENTED REALITY BOOK PENGENALAN OBJEK WISATA TAMAN UJUNG SOEKASADA DAN TAMAN AR TIRTA GANGGA DI KABUPATEN KARANGASEM

2014 ◽  
Vol 11 (2) ◽  
Author(s):  
Putu Angga Sudyatmika ◽  
Padma Nyoman Crisnapati ◽  
I Gede Mahendra Darmawiguna ◽  
Made Windu Antara Kesiman
Keyword(s):  
Augmented Reality ◽  
Research And Development ◽  
Tourist Attraction ◽  
3 Dimensional ◽  
Real Environment ◽  
The Village

Taman Ujung Soekasada and Tirta Gangga is a famous tourist attraction inKarangasem regency. Taman Ujung is located at the village of Tumbu, district of Karangasem. The park was built in 1919 by the king of Karangasem, namely I Gusti BagusJelantik with the purpose to entertain important guests who visitied the region of Karangasem.Tirta Gangga was rebuilt in 1948 on the initiative of The King of Karangasem namely AnakAgung Anglurah Ketut Karangasem. Situated in Ababi Village, 6 kilometers northern Taman Ujung Soekasada. This water park built as a place for bathing the King and his family.This research is aims to develop an android-based application that can be used as a medium for learning and preserving Taman Ujung Soekasada and Tirta Gangga. The researchmethod used was research and development by using the model of the waterfall. Thisapplication uses the vuforia library to display 3 dimensional building objects into a real environment by using the book and the android smartphone.The end of result is a book that contains about information and images related toTaman Ujung Soekasada and Tirta Gangga that functioned as a marker as well as android based on Augmented Rality application that is capable of displaying the object of Taman Ujung and Tirta Gangga buildings in 3 dimensional above the marker complete with thenarrative sound explanation

scholarly journals Special Issue on “Augmented Reality, Virtual Reality & Semantic 3D Reconstruction”

2021 ◽  
Vol 11 (18) ◽  
pp. 8590
Author(s):  
Zhihan Lv ◽  
Jing-Yan Wang ◽  
Neeraj Kumar ◽  
Jaime Lloret
Keyword(s):  
Virtual Reality ◽  
Augmented Reality ◽  
3D Reconstruction ◽  
Paradigm Shift ◽  
Special Issue ◽  
Key Technology ◽  
Viable Solution ◽  
The Way ◽  
Critical Needs

Augmented Reality is a key technology that will facilitate a major paradigm shift in the way users interact with data and has only just recently been recognized as a viable solution for solving many critical needs [...]

scholarly journals On-Demand Intraoperative 3-Dimensional Printing of Custom Cranioplastic Prostheses

2018 ◽  
Vol 15 (3) ◽  
pp. 341-349 ◽  
Author(s):  
Alexander I Evins ◽  
John Dutton ◽  
Sayem S Imam ◽  
Amal O Dadi ◽  
Tao Xu ◽  
...  
Keyword(s):  
3D Printing ◽  
Perioperative Complications ◽  
Ease Of Use ◽  
Patient Specific ◽  
Production Time ◽  
3 Dimensional ◽  
3D Print ◽  
Fused Deposition ◽  
On Demand ◽  
Dimensional Printing

Abstract BACKGROUND Currently, implantation of patient-specific cranial prostheses requires reoperation after a period for design and formulation by a third-party manufacturer. Recently, 3-dimensional (3D) printing via fused deposition modeling has demonstrated increased ease of use, rapid production time, and significantly reduced costs, enabling expanded potential for surgical application. Three-dimensional printing may allow neurosurgeons to remove bone, perform a rapid intraoperative scan of the opening, and 3D print custom cranioplastic prostheses during the remainder of the procedure. OBJECTIVE To evaluate the feasibility of using a commercially available 3D printer to develop and produce on-demand intraoperative patient-specific cranioplastic prostheses in real time and assess the associated costs, fabrication time, and technical difficulty. METHODS Five different craniectomies were each fashioned on 3 cadaveric specimens (6 sides) to sample regions with varying topography, size, thickness, curvature, and complexity. Computed tomography-based cranioplastic implants were designed, formulated, and implanted. Accuracy of development and fabrication, as well as implantation ability and fit, integration with exiting fixation devices, and incorporation of integrated seamless fixation plates were qualitatively evaluated. RESULTS All cranioprostheses were successfully designed and printed. Average time for design, from importation of scan data to initiation of printing, was 14.6 min and average print time for all cranioprostheses was 108.6 min. CONCLUSION On-demand 3D printing of cranial prostheses is a simple, feasible, inexpensive, and rapid solution that may help improve cosmetic outcomes; significantly reduce production time and cost—expanding availability; eliminate the need for reoperation in select cases, reducing morbidity; and has the potential to decrease perioperative complications including infection and resorption.

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