Magnetic Resonance based Neuronavigation and Infrared Optic Camera integrated Surgical Microscope with Augmented Reality for Neurooncologic Robotic Surgery

Project no. 28467 · Status: Kapanmış (Yayın bekleniyor) · 2023

Summary

Neuronavigation Systems, in their normal operating principles, display your location within the pre-planned area on the navigation system's screen using a probe and receiver. When communication is established with the operating microscope, the surgical site boundaries, routes, and nerve and vascular structures planned in the navigation system can be digitally transmitted to the operating microscope, thanks to the working distance, magnification, and camera image data sent from the operating microscope to the navigation device.In this method, the image from the neuronavigation device is transferred to the microscope's eyepiece in real time, allowing the surgeon to observe the surgical area while performing the surgery. This eliminates the need to pause the surgery, observe the neuronavigation device's screen, and then resume the surgery. This eliminates precision issues related to the device's calibration. Over the last 15 years, neuronavigation has become essential for minimally invasive and safe procedures in neurosurgical procedures. However, these systems are still not ergonomic. The surgeon must look at a separate screen, away from the surgical field, and interpret the virtual image on this screen against the actual surgical image. Augmented reality directly superimposes the real environment onto a virtual image. Therefore, it is a highly useful technology for future surgical planning. The primary goal is to match a patient-specific 3D virtual model, including anatomical details, with the actual surgical field. This enhances the actual surgical image in every way.Extended or Augmented Reality (AR) allows the superimposition of real and virtual images, enabling the user to interact with this created reality.Augmented reality studies are diverse. Imaging of the actual surgical field is achieved through microscopes, endoscopic cameras, hand-held cameras, or cameras mounted on the surgeon's head.A large number of studies have focused on AR with microscopes, and these systems have gained momentum with neuronavigation systems. Thanks to the integration of optical tracking-based neuronavigation systems used in existing clinics with microscopes, surgeons can view virtual 3D pathology or CT and MRI images in the surgical field from microscope images. Studies have shown that these technologies are beneficial for the surgeon. In tumor surgery, AR has been shown to be useful in incision planning for superficial lesions, craniotomy location and size, and tumor resection.A review of the literature reveals a very limited number of articles on the use of Microscope-Based Augmented Reality Integrated Navigation. The most recent article, published in Cancers (Basel) in 2022 by Pojskic et al., examined 39 meningioma cases. It was found that augmented reality increased the resection volume, facilitated orientation, protected cerebral vessels, and reduced damage to valuable tissues such as the optic chiasm. In 2016, in the journal World Neurosurgery, Sun and colleagues used this technology in glial tumors and found that it facilitated resection in eccentric areas and positively impacted the total resection rate and average resection extent. While there are very limited publications in the literature on this topic and technique, this represents pioneering work for an emerging new-generation surgical concept. We plan to actively utilize this system (MAGRC) in the treatment of neuro-oncological tumors and create the most comprehensive and extensive patient series using this system. No comprehensive and detailed patient series for intracranial and skull base masses is yet available in the literature. Therefore, the planned study aims to demonstrate the effectiveness of this system, namely the Surgical Microscope-Based Augmented Reality Robotic Neuro-Oncological Surgery (MAGRC) system, integrated with Optical-Based Magnetic Resonance-Based Infrared Camera-Based Neuronavigation. In their normal operating principles, all intracranial neuronavigation systems display your location on the navigation system's screen using a probe and receiver. However, upon communication with the operating microscope, the working distance, magnification, and camera image data sent from the operating microscope to the navigation device allow the navigation system to digitally transmit the planned surgical site boundaries, routes, and nerve and vascular structures.In this method, the image from the neuro-navigation device is transferred in real time to the microscope's eyepiece, allowing the surgeon to observe the surgery while it is being performed. This eliminates the need to pause the surgery, observe the neuro-navigation device's screen, and then resume the surgery, eliminating sensitivity issues related to device calibration. Over the last 15 years, neuronavigation has become essential for minimally invasive and safe surgery in neurosurgery. However, these systems are still not ergonomic. The surgeon must look at another screen, away from the surgical field. They must interpret the virtual image they see on this screen against the real surgical image. Augmented reality directly superimposes the virtual image onto the real environment. Therefore, it is a highly useful technology that can be used in surgical planning in the future. The primary goal is to match a patient-specific 3D virtual model, including anatomical details, with the real surgical field. This enhances the real surgical image in every way.Extended or Augmented Reality (AR) allows the superimposition of real and virtual images, allowing the user to interact with this created reality.Studies on augmented reality are diverse. The actual surgical field is visualized using cameras mounted on microscopes, endoscopic cameras, handheld cameras, or cameras mounted on the surgeon's head. Most studies have focused on AR with microscopes, and these systems have gained momentum with neuronavigation systems. Thanks to the integration of optical tracking-based neuronavigation systems used in existing clinics with microscopes, surgeons can view virtual 3D pathology or CT and MRI images of the surgical field from microscope images. Studies have shown that these technologies are beneficial for the surgeon. In tumor surgery, AR has been shown to be beneficial for incision planning for superficial lesions, craniotomy location and size, and tumor resection.A review of the literature reveals a very limited number of articles on the use of Microscope-Based Augmented Reality Integrated Navigation and its application. The most recent article, published in Cancers (Basel) in 2022 by Pojskic et al., examined 39 cases of meningioma. Augmented reality has been found to increase resection volume, facilitate orientation, protect cerebral vessels, and reduce damage to valuable tissues such as the optic chiasm. In 2016, Sun and colleagues published a report in the journal World Neurosurgery, using this technology in glial tumors and finding that it facilitates resection in eccentric areas and positively impacts the total resection rate and average resection extent. While there are very limited publications in the literature on this topic and technique, this represents pioneering work for an emerging new-generation surgical concept. We plan to actively utilize this system (MAGRC) in the treatment of neuro-oncological tumors and create the most comprehensive and extensive patient series using this system. No comprehensive and detailed patient series for intracranial and skull base masses has yet been published in the literature. Therefore, the planned study will be a pioneering study worldwide, as it will investigate the effectiveness of this system—an optical-based magnetic resonance-based infrared camera-based neuronavigation-integrated surgical microscope-based augmented reality-applied robotic neuro-oncological surgery (MAGRC) system—in all intracranial pathologies and determine whether it has different efficacy and success rates in different intracranial regions. In this respect, the work to be conducted within this project has a high degree of originality.Patients with intracranial lesions who are considered for surgery and who are eligible for surgery will be treated transcranially. Patient demographics, surgical goals, and success rates will be documented, and surgical evaluations will be conducted using preoperative and postoperative Magnetic Resonance imaging.Following project support, the study will include patients aged 18 and over who are newly diagnosed with skull base, cranium, and intracranial tumors and are scheduled for primary surgery. The total number of patients expected to be included in the study after being evaluated at our clinic for benign, premalignant, and malignant pathologies in the identified lower anatomical regions within approximately two years is 20.All intracranial lesions diagnosed with benign, premalignant, or malignant lesions will be operated on under general anesthesia. During these surgical procedures, the MAGRC system will not be used for surgical or nonsurgical definitive treatment procedures that could directly impact patient survival, cure rate, course of disease, or functional outcomes.The purpose of this study is to test the effectiveness of the Augmented Reality Robotic Neuro-Oncological Surgery (MAGRC) Approach, which utilizes an Optical-Based Magnetic Resonance-Based Infrared Camera and Neuronavigation Integrated with a Surgical Microscope, and to lay the groundwork for future prospective studies. The accuracy with which the MAGRC system and the surgeon can detect the size, borders, and location of important neurovascular structures of the mass in three stages (pre-incision, upon reaching the mass, and post-resection) will be documented and compared statistically.The investment in this project will yield clinical and academic benefits far exceeding the cost. With the implementation and dissemination of the Optical-Based Magnetic Resonance-Based Infrared Camera-Based Neuronavigation-Integrated Surgical Microscope-Based Augmented Reality Robotic Neuro-Oncological Surgery (MAGRC) Approach and the establishment of the Advanced Neuro-Oncological Surgery Program, Ege University Faculty of Medicine will maintain its status as a reference point in many areas and become a national and international center for Neuro-Oncological Surgery.A review of the literature reveals that no platform currently offers comprehensive and detailed patient series results on Microscope-Based Augmented Reality Integrated Navigation in Neuro-Oncological Surgery. In this respect, this study has a high originality. Furthermore, the data from numerous future studies using this method will be shared with the scientific community through numerous original articles and national and international symposiums.In addition to its contribution to the literature, it is believed that using this system will enable much more successful minimally invasive treatment for patients newly diagnosed with skull base, cranium, and intracranial tumors and those scheduled for primary surgery.This system, planned to be integrated into our hospital's infrastructure as part of this project, will not only produce scientific outputs for this research but also provide services. Because it can be used during a wide range of surgical procedures in neurosurgery, it will also form a crucial foundation for future specialist theses and national and international projects. Publications based on the results of these theses and projects will be published in high-impact journals and shared with the scientific community. Furthermore, online and live surgery courses, workshops, and congresses, organized in collaboration with international associations at our internationally renowned center for skull base, cranium, and intracranial tumors, will contribute to the international recognition of our university and our country. In the long term, the device's acquisition at our hospital will allow for the complete removal of cancerous tissue. This will reduce complications, recurrence rates, and hospital stays in the relevant patient population. It will also allow individuals to return to their normal lives, alleviating the burden on the Social Security Institution and indirectly contributing to the national economy.

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