Augmented Reality geführte Punktionsverfahren

Augmented reality (AR) is a technological megatrend that is increasingly being applied in many areas. The availability of this technology increasingly prompts the question of meaningful applications in clinical practice. We have investigated various use-cases.

Four AR devices (Magic Leap 1, Plantation, FA, USA) were used in combination with neurosurgical planning software (Elements, Brainlab, Munich) for various applications. Overall, 204 procedures in three intraoperative use-cases were investigated on phantoms regarding feasibility and accuracy in order to compare AR guided procedures to the respective standard methods. On a phantom with intracranial hemorrhage, a total of 60 operations for placement of hemorrhage drains (compared with freehand and sterotactic frame-based placement) were performed by 5 surgeons. Percutaneous placements of a cannula into the foramen ovale for ablation of the gasserian ganglion in trigeminal neuralgia were performed a total of 64 times by 4 subjects (compared with the landmark-based method). 80 placements of a cannula into a defined peridural target point in the lumbar spine were performed by 4 physicians. Placement accuracy was measured using computed tomography and the planning software.

In the phantom experiments, compared to freehand applications, AR was significantly more accurate in all cases studied (p<0.001 in hemorrhage drains, p<0.01 in ganglion gasseri and p<0.0001 spinal).

Nonetheless, when compared to a stereotactic approach based on frames in the phantom experiment regarding bleeding drains, the Euclidean distance achieved using AR (median 3 mm) was lower, but it was comparable to that achieved using STX (median 1.95 mm; P=0.023). In an emergency situation, this could be offset by the better time efficiency of bedside procedures using AR compared to a stereotactic operation.

AR is an interesting technical development that allows intraoperative applications for cases that are performed landmark-based (e.g. puncture of the foramen ovale or spinal punctures) or where bed-side procedures are performed due to urgency (e.g. hemorrhage drainage).