Usage of augmented reality for interventional neuraxial procedures

European Journal of Anaesthesiology, vol. 40, pp. 121–129

Abstract

BACKGROUND: Neuraxial access is necessary for an array of procedures in anaesthesia, interventional pain medicine and neurosurgery. The commonly used anatomical landmark technique is challenging and requires practical experience. OBJECTIVE: We aimed to evaluate the technical feasibility of an augmented reality-guided approach for neuraxial access and tested the hypothesis that its use would improve success as the primary outcome. As secondary outcomes, we measured accuracy and the procedural duration compared with the classical landmark approach. DESIGN: A randomised phantom-based study. SETTING: The three-dimensional image of a thoracolumbar phantom spine model with the surrounding soft tissue was created with a neurosurgical planning workstation and ideal trajectories to the epidural space on the levels T10-L1 were planned using a paramedian approach. Both the three-dimensional holographic image of the spine and the trajectories were transferred to an augmented reality-headset. Four probands (two anaesthesiologists, one neuroradiologist and one stereotactic neurosurgeon) performed 20 attempts, 10 each of either conventional landmark or augmented reality-guided epidural punctures, where anatomical level, side and sequence of modality were all randomised. OUTCOME MEASURES: Accuracy was assessed by measuring Euclidean distance and lateral deviation from the predefined target point. Success of epidural puncture on the first attempt was compared between the conventional and the augmented reality-guided approaches. RESULTS: Success was achieved in 82.5% of the attempts using augmented reality technique, compared with 40% with the conventional approach [ P = 0.0002, odds ratio (OR) for success: 7.07]. Euclidean distance (6.1 vs. 12 mm, P < 0.0001) and lateral deviation (3.7 vs. 9.2 mm, P < 0.0001) were significantly smaller using augmented reality. Augmented reality-guided puncture was significantly faster than with the conventional landmark approach (52.5 vs. 67.5 s, P = 0.0015). CONCLUSION: Augmented reality guidance significantly improved the accuracy and success in an experimental phantom model of epidural puncture. With further technical development, augmented reality guidance might prove helpful in anatomically challenging neuraxial procedures.

Authors 4

1. Peter Christoph Reinacher Aachen Department of Stereotactic and Functional Neurosurgery (PCR) Department of Anesthesiology & Critical Care (AC Department of Neuroradiology (TD) Faculty of Medicine, University of Freiburg, Germany (PCR NS) and Fraunhofer Institute for Laser Technology (ILT)

   University of Freiburg · University Medical Center Freiburg · Fraunhofer Institute for Laser Technology

   Affiliation as printed

   From the Department of Stereotactic and Functional Neurosurgery (PCR), Department of Anesthesiology & Critical Care (AC, NS), Department of Neuroradiology (TD), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany (PCR, AC, TD, NS) and Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany (PCR)

   the Department of Stereotactic and Functional Neurosurgery (PCR), Department of Anesthesiology & Critical Care (AC, NS), Department of Neuroradiology (TD), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany (PCR, AC, TD, NS) and Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany (PCR)

2. Anina Cimniak Aachen Department of Stereotactic and Functional Neurosurgery (PCR) Department of Anesthesiology & Critical Care (AC Department of Neuroradiology (TD) Faculty of Medicine, University of Freiburg, Germany (PCR NS) and Fraunhofer Institute for Laser Technology (ILT)

   University of Freiburg · University Medical Center Freiburg · Fraunhofer Institute for Laser Technology

   Affiliation as printed

   the Department of Stereotactic and Functional Neurosurgery (PCR), Department of Anesthesiology & Critical Care (AC, NS), Department of Neuroradiology (TD), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany (PCR, AC, TD, NS) and Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany (PCR)

3. Theo Demerath Aachen Department of Stereotactic and Functional Neurosurgery (PCR) Department of Anesthesiology & Critical Care (AC Department of Neuroradiology (TD) Faculty of Medicine, University of Freiburg, Germany (PCR NS) and Fraunhofer Institute for Laser Technology (ILT)

   University of Freiburg · University Medical Center Freiburg · Fraunhofer Institute for Laser Technology

   Affiliation as printed

   the Department of Stereotactic and Functional Neurosurgery (PCR), Department of Anesthesiology & Critical Care (AC, NS), Department of Neuroradiology (TD), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany (PCR, AC, TD, NS) and Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany (PCR)

4. Nils Schallner corresponding Aachen Department of Stereotactic and Functional Neurosurgery (PCR) Department of Anesthesiology & Critical Care (AC Department of Neuroradiology (TD) Faculty of Medicine, University of Freiburg, Germany (PCR NS) and Fraunhofer Institute for Laser Technology (ILT)

   University of Freiburg · University Medical Center Freiburg · Fraunhofer Institute for Laser Technology

   Affiliation as printed

   the Department of Stereotactic and Functional Neurosurgery (PCR), Department of Anesthesiology & Critical Care (AC, NS), Department of Neuroradiology (TD), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany (PCR, AC, TD, NS) and Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany (PCR)

   to Nils Schallner, Prof. Dr med. Department of Anesthesiology & Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany, Hugstetter Street 55, 79106 Freiburg, Germany Tel: +49 761 270 23060; fax: +49 761 270 23960; e-mail: [email protected]

   e-mail: [email protected]

   fax: +49 761 270 23960

   to Nils Schallner, Prof. Dr med. Department of Anesthesiology & Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany, Hugstetter Street 55, 79106 Freiburg, Germany Tel: +49 761 270 23060