Introduction: Augmented Reality (AR) enables interaction with 3-dimensional (3D) holograms without obstruction of the user’s view of their surroundings. We employed this technology to develop a system, HoloEVD, to improve external ventricular drain (EVD) catheter placement. The system digitally projects a 3D model of the patient’s ventricular system in the anatomically correct position in the skull and provides navigational aids for guiding the catheter from the burr hole to ventricle. Although EVD placement is a commonly performed procedure, small and shifted ventricles can complicate placement when using anatomical landmarks for starting point and trajectory. We tested the ability of the HoloEVD system to aid in EVD placement in both normal and shifted ventricular configurations.
Methods: Neurosurgical Residents were shown two CT scans of patients in need of EVD placement. Patient A had globally dilated ventricles, while Patient B had shifted and collapsed ventricles. The subjects were then asked to place an EVD in each scenario with and without the aid of our AR system in a generic model of the cranium containing a material imitating brain tissue. A secondary system tracked in real-time the ending location of the tip of the EVD catheter. Distance to target were compared for each scenario.
Results: Early results show improvement in both the accuracy and precision of the catheter placement when our HoloEVD system was employed. This effect was more pronounced in the case of the patient with the small shifted ventricular system.
Conclusions: The HoloEVD system improved the accuracy and precision of the EVD catheter’s location in a model of EVD placement. These early results form the basis of continued development of the software with the next steps of improving the system’s functionality and usability, and exploring its role in procedural education.
Patient Care: This software platform has the potential to improve patient care by increasing the accuracy in which we are able to perform procedures. This is accomplished not only through the navigational aid, but also through the placement of patient-specific imaging and data directly over the relevant anatomy. The data no longer becomes a distraction and is presented in a manner that is logical and in line with procedural work flows. By more accurately performing procedures, the rate of complications should decrease, resulting in direct improvements to patient outcomes and procedural times. This device also has the potential to improve procedural education for both model-based and patient-based training, which will be explored in additional upcoming testing.
Learning Objectives: By the conclusion of this session, participants should be able to understand the concept of augmented reality and how it can be applied in neurosurgery for navigation using a mobile headset. Participants will also be able to see the potential of this technology to improve procedural accuracy in a novel manner.