Visualization, navigation, augmentation. The ever-changing perspective of the neurosurgeon

Brain and Spine, vol. 2, pp. 100926

Abstract

Introduction: The evolution of neurosurgery coincides with the evolution of visualization and navigation. Augmented reality technologies, with their ability to bring digital information into the real environment, have the potential to provide a new, revolutionary perspective to the neurosurgeon. Research question: To provide an overview on the historical and technical aspects of visualization and navigation in neurosurgery, and to provide a systematic review on augmented reality (AR) applications in neurosurgery. Material and methods: We provided an overview on the main historical milestones and technical features of visualization and navigation tools in neurosurgery. We systematically searched PubMed and Scopus databases for AR applications in neurosurgery and specifically discussed their relationship with current visualization and navigation systems, as well as main limitations. Results: The evolution of visualization in neurosurgery is embodied by four magnification systems: surgical loupes, endoscope, surgical microscope and more recently the exoscope, each presenting independent features in terms of magnification capabilities, eye-hand coordination and the possibility to implement additional functions. In regard to navigation, two independent systems have been developed: the frame-based and the frame-less systems. The most frequent application setting for AR is brain surgery (71.6%), specifically neuro-oncology (36.2%) and microscope-based (29.2%), even though in the majority of cases AR applications presented their own visualization supports (66%). Discussion and conclusions: The evolution of visualization and navigation in neurosurgery allowed for the development of more precise instruments; the development and clinical validation of AR applications, have the potential to be the next breakthrough, making surgeries safer, as well as improving surgical experience and reducing costs.

Authors 7

1. Alessandro Boaro corresponding

   University of Verona

   Affiliation as printed

   Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy

2. F. Moscolo

   University of Verona

   Affiliation as printed

   Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy

3. Alberto Feletti

   University of Verona

   Affiliation as printed

   Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy

4. G.M.V. Polizzi

   University of Verona

   Affiliation as printed

   Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy

5. Francesca Siddi

   Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum

   Affiliation as printed

   Department of Neurosurgery, Haaglanden Medical Center, The Hague, Zuid-Holland, the Netherlands

6. Marike L. D. Broekman Aachen Department of Neurosurgery, Leiden University Medical Center

   Leiden University Medical Center · Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum

   Affiliation as printed

   Department of Neurosurgery, Haaglanden Medical Center, The Hague, Zuid-Holland, the Netherlands

   Department of Neurosurgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands

7. Francesco Sala

   University of Verona

   Affiliation as printed

   Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy