Augmented reality (AR) in microsurgical multimodal image guided focal pediatric epilepsy surgery: Results of a retrospective feasibility study

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine Pub Date : 2025-01-01 DOI:10.1016/j.bas.2024.104180

Julia Shawarba , Matthias Tomschik , Jonathan Wais , Fabian Winter , Christian Dorfer , Florian Mayer , Martha Feucht , Karl Roessler

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Abstract

Introduction and research question

Augmented reality (AR) is increasingly being used to improve surgical planning and assist in real time surgical procedures. A retrospective investigation was conducted to study its feasibility in pediatric epilepsy surgery at a single institution.

Methods

Functional neuronavigation using multimodal imaging data (fMRI, DTI-tractography, PET, SPECT, sEEG) were used to augment the surgical navigation by transferring MRI imaging reconstructions as AR maps into the surgical microscope overlaying the surgical field.

Results

Altogether, 43 patients (17 female, 0–18 yrs, mean 9 yrs) were operated between 10/2020 and 10/2023 and fulfilled the inclusion criteria. 26 patients (60.5%) had an extra-temporal and 17 (39.5%) a temporal seizure origin. The 3 top histological diagnoses encountered were: FCD (32.6%), ganglioglioma (23.3%) and DNET (11.6%). Preoperative MRI studies showed no epileptogenic lesion in 11 patients (25.6%, MRI negativ group), which necessitated implantation of depth electrodes before resection. There were no adverse events while using AR enhanced neuronavigation. Altogether, of 24 patients with a follow up of more than one year, 83.3% displayed a favorable ILAE grade 1 seizure outcome (75% ILAE 1a), 14 % experienced a transient hemiparesis, 4.3% a permanent quadrantanopia and one needed a subdural-peritoneal shunt.

Discussion and conclusion

AR supported navigated microscope resection allowed targeting and removal of lesional as well as non-lesional (sEEG defined) epileptogenic zones in pediatric epilepsy surgery with low morbidity and an expected seizure outcome.

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增强现实（AR）显微外科多模态图像引导局灶性小儿癫痫手术：回顾性可行性研究的结果。

介绍和研究问题：增强现实（AR）越来越多地被用于改进手术计划和辅助实时手术过程。回顾性研究其在单一机构小儿癫痫手术中的可行性。方法：利用多模态成像数据（fMRI, DTI-tractography， PET， SPECT, sEEG）进行功能神经导航，通过将MRI成像重建作为AR图传输到覆盖手术视野的手术显微镜中来增强手术导航。结果：2020年10月至2023年10月共手术43例患者，其中女性17例，年龄0 ~ 18岁，平均9岁，符合纳入标准。颞外发病26例（60.5%），颞外发病17例（39.5%）。排在前三位的组织学诊断为：FCD（32.6%）、神经节胶质瘤（23.3%）和DNET（11.6%）。术前MRI检查显示11例患者（25.6%，MRI阴性组）未见致痫性病变，需在切除前植入深度电极。使用AR增强神经导航无不良事件发生。总的来说，在随访超过一年的24例患者中，83.3%的患者表现出有利的ILAE 1级癫痫发作结果（75%的ILAE 1a）， 14%的患者经历了一过性偏瘫，4.3%的患者出现了永久性的象限视，1例患者需要硬膜下-腹膜分流术。讨论和结论：AR支持的导航显微镜切除可以靶向和切除儿童癫痫手术中的病变区和非病变区（sEEG定义），发病率低，癫痫发作结果预期。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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