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Augmented reality in intraventricular neuroendoscopy

Acta Neurochirurgica volume 159, pages 1033–1041 (2017)Cite this article

Abstract

Background

Individual planning of the entry point and the use of navigation has become more relevant in intraventricular neuroendoscopy. Navigated neuroendoscopic solutions are continuously improving.

Objective

We describe experimentally measured accuracy and our first experience with augmented reality-enhanced navigated neuroendoscopy for intraventricular pathologies.

Patients and methods

Augmented reality-enhanced navigated endoscopy was tested for accuracy in an experimental setting. Therefore, a 3D-printed head model with a right parietal lesion was scanned with a thin-sliced computer tomography. Segmentation of the tumor lesion was performed using Scopis NovaPlan navigation software. An optical reference matrix is used to register the neuroendoscope’s geometry and its field of view. The pre-planned ROI and trajectory are superimposed in the endoscopic image. The accuracy of the superimposed contour fitting on endoscopically visualized lesion was acquired by measuring the deviation of both midpoints to one another. The technique was subsequently used in 29 cases with CSF circulation pathologies. Navigation planning included defining the entry points, regions of interests and trajectories, superimposed as augmented reality on the endoscopic video screen during intervention. Patients were evaluated for postoperative imaging, reoperations, and possible complications.

Results

The experimental setup revealed a deviation of the ROI’s midpoint from the real target by 1.2 ± 0.4 mm. The clinical study included 18 cyst fenestrations, ten biopsies, seven endoscopic third ventriculostomies, six stent placements, and two shunt implantations, being eventually combined in some patients. In cases of cyst fenestrations postoperatively, the cyst volume was significantly reduced in all patients by mean of 47%. In biopsies, the diagnostic yield was 100%. Reoperations during a follow-up period of 11.4 ± 10.2 months were necessary in two cases. Complications included one postoperative hygroma and one insufficient fenestration.

Conclusions

Augmented reality-navigated neuroendoscopy is accurate and feasible to use in clinical application. By integrating relevant planning information directly into the endoscope’s field of view, safety and efficacy for intraventricular neuroendoscopic surgery may be improved.

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References

  1. Ahn ES, Goumnerova L (2010) Endoscopic biopsy of brain tumors in children: diagnostic success and utility in guiding treatment strategies. J Neurosurg Pediatr 5:255–262

    Article  PubMed  Google Scholar 

  2. Alberti O, Riegel T, Hellwig D, Bertalanffy H (2001) Frameless navigation and endoscopy. J Neurosurg 95:541–543

    CAS  PubMed  Google Scholar 

  3. Choudhri O, Mindea SA, Feroze A, Soudry E, Chang SD, Nayak JV (2014) Experience with intraoperative navigation and imaging during endoscopic transnasal spinal approaches to the foramen magnum and odontoid. Neurosurg Focus 36:E4

    Article  PubMed  Google Scholar 

  4. Constantini S, Mohanty A, Zymberg S, Cavalheiro S, Mallucci C, Hellwig D, Ersahin Y, Mori H, Mascari C, Val JA, Wagner W, Kulkarni AV, Sgouros S, Oi S (2013) Safety and diagnostic accuracy of neuroendoscopic biopsies: an international multicenter study. J Neurosurg Pediatr 11:704–709

    Article  PubMed  Google Scholar 

  5. Di Ieva A, Tam M, Tschabitscher M, Cusimano MD (2014) A journey into the technical evolution of neuroendoscopy. World Neurosurg 82:e777–e789

    Article  PubMed  Google Scholar 

  6. Dixon BJ, Daly MJ, Chan H, Vescan A, Witterick IJ, Irish JC (2014) Augmented real-time navigation with critical structure proximity alerts for endoscopic skull base surgery. Laryngoscope 124:853–859

    Article  PubMed  Google Scholar 

  7. Fiorindi A, Delitala A, Francaviglia N, Longatti P (2013) Neuroendoscopic options in the treatment of mesencephalic expanding cysts: report of four cases and review of the literature. Clin Neurol Neurosurg 115:2370–2376

    Article  PubMed  Google Scholar 

  8. Fukushima T (1978) Endoscopic biopsy of intraventricular tumors with the use of a ventriculofiberscope. Neurosurgery 2:110–113

    Article  CAS  PubMed  Google Scholar 

  9. Golfinos JG, Fitzpatrick BC, Smith LR, Spetzler RF (1995) Clinical use of a frameless stereotactic arm: results of 325 cases. J Neurosurg 83:197–205

    Article  CAS  PubMed  Google Scholar 

  10. Hayashi N, Murai H, Ishihara S, Kitamura T, Miki T, Miwa T, Miyajima M, Nishiyama K, Ohira T, Ono S, Suzuki T, Takano S, Date I, Saeki N, Endo S (2011) Nationwide investigation of the current status of therapeutic neuroendoscopy for ventricular and paraventricular tumors in Japan. J Neurosurg 115:1147–1157

    Article  PubMed  Google Scholar 

  11. Hsu W, Li KW, Bookland M, Jallo GI (2009) Keyhole to the brain: Walter Dandy and neuroendoscopy. J Neurosurg Pediatr 3:439–442

    Article  PubMed  Google Scholar 

  12. Kawamata T, Iseki H, Shibasaki T, Hori T (2002) Endoscopic augmented reality navigation system for endonasal transsphenoidal surgery to treat pituitary tumors: technical note. Neurosurgery 50:1393–1397

    PubMed  Google Scholar 

  13. Kim K, Yeon JY, Seol HJ, Shin HJ (2013) Transventricular endoscopic biopsy of suprasellar tumors: a pediatric case series. Childs Nerv Syst 29:1285–1291

    Article  PubMed  Google Scholar 

  14. Knaus H, Abbushi A, Hoffmann KT, Schwarz K, Haberl H, Thomale UW (2009) Measurements of burr-hole localization for endoscopic procedures in the third ventricle in children. Childs Nerv Syst 25:293–299

    Article  CAS  PubMed  Google Scholar 

  15. Knaus H, Matthias S, Koch A, Thomale UW (2011) Single burr hole endoscopic biopsy with third ventriculostomy-measurements and computer-assisted planning. Childs Nerv Syst 27:1233–1241

    Article  PubMed  Google Scholar 

  16. Kulkarni AV, Sgouros S, Constantini S, Investigators I (2016) International infant hydrocephalus study: initial results of a prospective, multicenter comparison of endoscopic third ventriculostomy (ETV) and shunt for infant hydrocephalus. Childs Nerv Syst 32(6):1039–1048

    Article  PubMed  Google Scholar 

  17. Lee MH, Kim HR, Seol HJ, Shin HJ (2014) Neuroendoscopic biopsy of pediatric brain tumors with small ventricle. Childs Nerv Syst 30:1055–1060

    Article  PubMed  Google Scholar 

  18. Li L, Zhang Y, Li Y, Zhai X, Zhou Y, Liang P (2013) The clinical classification and treatment of middle cranial fossa arachnoid cysts in children. Clin Neurol Neurosurg 115:411–418

    Article  PubMed  Google Scholar 

  19. Li Y, Chen X, Xu B (2014) The efficacy of neuroendoscopic treatment for middle cranial fossa arachnoid cysts assessed by MRI 3D segmentation and modeling. Childs Nerv Syst 30:1037–1044

    Article  PubMed  Google Scholar 

  20. Limbrick DD Jr, Baird LC, Klimo P Jr, Riva-Cambrin J, Flannery AM, Pediatric Hydrocephalus Systematic R, Evidence-Based Guidelines Task F (2014) Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 4: cerebrospinal fluid shunt or endoscopic third ventriculostomy for the treatment of hydrocephalus in children. J Neurosurg Pediatr 14(Suppl 1):30–34

    Article  PubMed  Google Scholar 

  21. Luther N, Cohen A, Souweidane MM (2005) Hemorrhagic sequelae from intracranial neuroendoscopic procedures for intraventricular tumors. Neurosurg Focus 19:E9

    Article  PubMed  Google Scholar 

  22. Martinez-Moreno M, Widhalm G, Mert A, Kiesel B, Bukaty A, Furtner J, Reinprecht A, Knosp E, Wolfsberger S (2014) A novel protocol of continuous navigation guidance for endoscopic third ventriculostomy. Neurosurgery 10(Suppl 4):514–523 discussion 523-514

    Article  PubMed  Google Scholar 

  23. Nanda A, Ambekar S (2014) Expanding the realms of navigation in neurosurgery. World Neurosurg 82:e187–e188

    Article  PubMed  Google Scholar 

  24. Nanda A, Sonig A (2014) The expansive realm of skull base neuroendoscopy. World Neurosurg 82:e423–e425

    Article  PubMed  Google Scholar 

  25. Paraskevopoulos D, Biyani N, Constantini S, Beni-Adani L (2011) Combined intraoperative magnetic resonance imaging and navigated neuroendoscopy in children with multicompartmental hydrocephalus and complex cysts: a feasibility study. J Neurosurg Pediatr 8:279–288

    Article  PubMed  Google Scholar 

  26. Prat R, Galeano I (2009) Endoscopic biopsy of foramen of Monro and third ventricle lesions guided by frameless neuronavigation: usefulness and limitations. Clin Neurol Neurosurg 111:579–582

    Article  PubMed  Google Scholar 

  27. Raheja A, Kalra R, Couldwell WT (2016) Three-dimensional versus two-dimensional neuroendoscopy: a preclinical laboratory study. World Neurosurg 92:378–385

    Article  PubMed  Google Scholar 

  28. Roessler K, Czech T, Dietrich W, Ungersboeck K, Nasel C, Hainfellner JA, Koos WT (1998) Frameless stereotactic-directed tissue sampling during surgery of suspected low-grade gliomas to avoid histological undergrading. Minim Invasive Neurosurg 41:183–186

    Article  CAS  PubMed  Google Scholar 

  29. Roessler K, Ungersboeck K, Czech T, Aichholzer M, Dietrich W, Goerzer H, Matula C, Koos WT (1997) Contour-guided brain tumor surgery using a stereotactic navigating microscope. Stereotact Funct Neurosurg 68:33–38

    Article  CAS  PubMed  Google Scholar 

  30. Rohde V, Reinges MH, Krombach GA, Gilsbach JM (1998) The combined use of image-guided frameless stereotaxy and neuroendoscopy for the surgical management of occlusive hydrocephalus and intracranial cysts. Br J Neurosurg 12:531–538

    Article  CAS  PubMed  Google Scholar 

  31. Schulz M, Bohner G, Knaus H, Haberl H, Thomale UW (2010) Navigated endoscopic surgery for multiloculated hydrocephalus in children. J Neurosurg Pediatr 5:434–442

    Article  PubMed  Google Scholar 

  32. Schulz M, Buhrer C, Pohl-Schickinger A, Haberl H, Thomale UW (2014) Neuroendoscopic lavage for the treatment of intraventricular hemorrhage and hydrocephalus in neonates. J Neurosurg Pediatr 13:626–635

    Article  PubMed  Google Scholar 

  33. Schulz M, Kimura T, Akiyama O, Shimoji K, Spors B, Miyajima M, Thomale UW (2015) Endoscopic and microsurgical treatment of Sylvian fissure arachnoid cysts-clinical and radiological outcome. World Neurosurg 84:327–336

    Article  PubMed  Google Scholar 

  34. Somji M, Badhiwala J, McLellan A, Kulkarni AV (2016) Diagnostic yield, morbidity, and mortality of Intraventricular Neuroendoscopic biopsy: systematic review and meta-analysis. World Neurosurg 85(315–324):e312

    Google Scholar 

  35. Song JH, Kong DS, Seol HJ, Shin HJ (2010) Transventricular biopsy of brain tumor without hydrocephalus using Neuroendoscopy with navigation. J Korean Neurosurg Soc 47:415–419

    Article  PubMed  PubMed Central  Google Scholar 

  36. Thomale UW, Stover JF, Unterberg AW (2005) The use of neuronavigation in transnasal transsphenoidal pituitary surgery. Zentralbl Neurochir 66:126–132 discussion 132

    Article  PubMed  Google Scholar 

  37. Winne C, Khan M, Stopp F, Jank E, Keeve E (2011) Overlay visualization in endoscopic ENT surgery. Int J Comput Assist Radiol Surg 6:401–406

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    T. Finger, A. Schaumann, M. Schulz & Ulrich-W. Thomale

  2. Department of Neurosurgery, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    T. Finger

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  1. T. Finger
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  2. A. Schaumann
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  3. M. Schulz
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  4. Ulrich-W. Thomale
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Correspondence to Ulrich-W. Thomale.

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Funding

No funding was received for this research.

Conflict of interest

UWT received honoraria from Scopis as well as Brainlab as lecturer and for consultancies. No further conflict of interest exists for UWT or the other authors listed above.

Ethical approval

All procedures performed in studies involving humanparticipants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of retrospective study formal consent is not required.

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Finger, T., Schaumann, A., Schulz, M. et al. Augmented reality in intraventricular neuroendoscopy. Acta Neurochir 159, 1033–1041 (2017). https://doi.org/10.1007/s00701-017-3152-x

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  • DOI: https://doi.org/10.1007/s00701-017-3152-x

Keywords

  • Neuroendoscopy
  • Neuronavigation
  • Augmented reality
  • Hydrocephalus
  • Brain tumors