Augmented reality neurosurgical planning and navigation for surgical excision of parasagittal, falcine and convexity meningiomas.

OBJECTIVE: To assess the utility of pre-operative 3-dimension (3D) visualisation and surgical planning with the Dextroscope in combination with the use of DEX-Ray-a novel augmented reality surgical navigation platform for resection of meningiomas in the falcine, convexity and parasagittal regions. METHODS AND
RESULTS: Magnetic resonance imaging (MRI) and magnetic resonance venogram (MRV) images of the patients were reconstructed in 3D using the Dextroscope workstation. Using a variety of available tools, we were able to view the tumour in various surgical angles and appreciate the intricate relationship of the tumour with respect to the surrounding structures and venous anatomy. Critical draining veins both superficial and deep to the tumour were well visualised. By varying the transparency of the overlying scalp and bone we were able to preoperatively determine the ideal size of our scalp flap and bone window for surgical approach. The Dextroscope enabled us to simulate surgical opening and various trajectories of approach while the DexRay virtual reality navigation system enabled the transfer of the Dextroscope 3D planning data into the operating by displaying it in real-time video-augmented mode which further enhanced the appreciation of the tumour's location in 3D space. Four patients underwent total excision of their meningioma while one patient had near total excision with a small residual remnant left behind at the medial third of the superior sagittal sinus. All 5 patients had good neurological recovery post-operatively.
CONCLUSION: The use of the Dextroscope for pre-operative surgical planning allows for appreciation of complex anatomical relationships in 3D. This appreciation is further translated for use during surgical navigation utilizing the DEX-Ray platform that provided us with the superior advantage of allowing fast and accurate surgical resection confidently.