Novel planning pipeline utilizing the Surgical Theater system for pediatric epilepsy surgery.

Abstract

Objective: Advances in the analysis and collation of radiographic datasets have enhanced presurgical planning for various neurosurgical procedures, including clipping of cerebral aneurysms, surgical resection of tumors, and arteriovenous malformation management. The surgical theater (ST) system converts radiographic datasets, traditionally interpreted as a series of two-dimensional images, into three-dimensional interactive models better allowing understanding of anatomy as well as the complex anatomic relationships between different diagnostic phase I datasets.

Methods: We reviewed the capabilities and impact of the ST system on patients treated by our pediatric epilepsy service at our institution.

Results: The ST system was used in the treatment of 85 patients in our pediatric epilepsy service. Multiple layers of phase I data were converted into a single, multi-layered 3D model which added precision to points of collaboration on creating Phase II plans, allowed for the collaborative creation of detailed surgical plans and facilitated VR practice of complex surigcal plans with intraoperative augmented reality navigation. We highlight both current and future applications and present 4 cases to illustrate how ST is applied in our clinical setting.

Significance: The multi-layered and 3D model of the ST system facilitates epilepsy decision-making for both diagnosis and treatment, enhances surgical navigation, and even allows, in a robust virtual reality (VR) environment, the practice of complex surgical procedures.

Plain language summary: The surgical theater (ST) system converts two-dimensional imaging tests (eg MRI, MEG, CT and PET) into three-dimensional interactive models. This helps physicians understand complex Phase I datasets and make decisions for the diagnosis and treatment of pediatric epilepsy. These models also facilitate patient and family education, which may reduce their anxiety. In this article, we discuss the current and future applications of the ST system and how it is used to treat pediatric patients with epilepsy at our Institution. We also describe four of our patients to show how the ST system works in a clinical setting.