Virtual reality (VR) is increasingly being used to improve surgical planning and assist in real time surgical procedures. A retrospective investigation was conducted to investigate its role in pediatric epilepsy surgery at our institution.
Functional neuronavigation using multimodal imaging data (fMRI, DTI-tractography, PET, SPECT, sEEG) were used to augment the surgical navigation by transferring 3D imaging reconstructions as VR maps into the surgical microscope during surgery. Additionally, a navigated suction tool used for surgery was displayed in the virtual reality display and used for orientation during surgery. Real time augmentation of the surgery was performed using this dynamic VR information.
Altogether, 43 patients (17 female, 0-18 yrs, mean 9 yrs) were operated between 10/2020 and 10/2023 and fulfilled all inclusion criteria. 26 patients (60.5%) had an extra-temporal and 17 (39.5%) a temporal seizure origin. Preoperative MRI studies were negative in 11 patients (25.6%), which necessitated implantation of depth electrodes before resection. Advantages of VR augmentation comprised: 1. on-line targeting of the lesions, 2. avoiding injury of eloquent structures, 3. contour-guided resection of lesions even in cases with unclear visual delineation, and 4. estimation of the resection amount at the end of surgery.
Altogether, of 25 patients with a follow up of over one year, 83% displayed a favorable seizure outcome with ILAE 1 (75% ILAE 1a). One patient was found to have postoperative hemianopia, but no complications leading to surgical revision were encountered.
VR augmented microscope resection facilitated targeting and removal of lesional as well as non-lesional (sEEG guided) epileptogenic zones in pediatric epilepsy surgery with low morbidity and a remarkably good seizure outcome.