Original ArticleImpact of Virtual and Augmented Reality Based on Intraoperative Magnetic Resonance Imaging and Functional Neuronavigation in Glioma Surgery Involving Eloquent Areas
Introduction
Virtual reality (VR) can simulate the real world and provide information that may not be otherwise visible to the naked eye, allowing users to visualize objects within a 3-dimensional (3D) space without limits. However, the lack of interaction between VR and the real world limits its widespread application.1, 2
Augmented reality (AR) is a new cross-discipline based on VR that superimposes computer-generated virtual objects in real time and space with auxiliary enhancement such that the user perceives a real-world scene rather than a virtual phenomenon (the so-called enhanced concept). AR technology has been preliminarily applied to neurosurgery.3, 4 In this study, we investigated the utility of combined VR and AR for intraoperative magnetic resonance imaging (iMRI) and neuronavigation in glioma surgery.
Section snippets
Patient Population
A total of 134 consecutive patients with gliomas involving eloquent (motor, language, and vision) areas were prospectively recruited between February 2009 and January 2014. Of these patients, 79 underwent surgery using functional neuronavigation and iMRI and 55 underwent surgery guided by anatomic neuronavigation, comprising the patient and control groups, respectively. The study protocol was approved by our institutional ethics committee, and all patients or their family members provided
General
Glioma patients were diagnosed as LGG [World Health Organization (WHO) grades I and II) or HGG (WHO grades III and IV). The related eloquent area was reconstructed and localized, and their relationship to lesions was demonstrated and recorded in each patient. We defined reconstructed structures related to language (Broca's and Wernicke's areas and arcuate fasciculus), motor (hand and foot cortices and pyramidal tract), and vision (optic radiation and visual cortex) as eloquent areas.
Discussion
In the study, we found that VR based on functional neuronavigation was useful for optimizing surgical planning. Intraoperative 3D visualization of lesions and their associated functional structures (AR) can provide information to neurosurgeons for performing specific manipulations. Moreover, iMRI can detect brain shift during the surgical process and provide quality control during surgery. Most previous studies have focused on a single type of neurologic function, and the relationship between
Conclusion
The VR and AR technique described in our study can help the neurosurgeon design and optimize surgical planning and intraoperatively visualize structures around the lesions. iMRI can confirm brain shift and provide quality control during the surgical process. Thus, the combination of these techniques can significantly enhance resection of gliomas involving eloquent areas.
Acknowledgments
The authors thank the members of the Department of Neurosurgery, PLA General Hospital (Hao Tang, MD; Hai-hao Gao, MD; Xing-hua Xu, MD; and Qun Wang, MD) for their collaboration.
References (25)
- et al.
Intraoperative IMRI with integrated functional neuronavigation-guided resection of supratentorial cavernous malformations in eloquent brain areas
J Clin Neurosci
(2011) - et al.
Awake craniotomy and electrophysiological mapping for eloquent area tumours
Clin Neurol Neurosurg
(2013) - et al.
Intra-operative detection of motor pathways using a simple electrode provides safe brain tumor surgery
J Clin Neurosci
(2007) - et al.
Prediction of visual field deficits by diffusion tensor imaging in temporal lobe epilepsy surgery
Neuroimage
(2009) - et al.
Augmented reality-assisted skull base surgery
Neurochirurgie
(2014) - et al.
Intraoperative tractography and motor evoked potential (MEP) monitoring in surgery for gliomas around the corticospinal tract
World Neurosurg
(2010) - et al.
A neurosurgical phantom-based training system with ultrasound simulation
Acta Neurochir (Wien)
(2014) - et al.
Functional outcome after language mapping for insular World Health Organization Grade II gliomas in the dominant hemisphere: experience with 24 patients
Neurosurg Focus
(2009) - et al.
Utilization of intraoperative motor mapping in glioma surgery with high-field intraoperative magnetic resonance imaging
Stereotact Funct Neurosurg
(2010) - et al.
Simulation and augmented reality in endovascular neurosurgery: lessons from aviation
Neurosurgery
(2013)
Computerized tomography of cranial sutures. Part 2: abnormalities of sutures and skull deformity in craniosynostosis
J Neurosurg
Preoperative evaluation of neurovascular relationships for microvascular decompression in the cerebellopontine angle in a VR environment
J Neurosurg
Cited by (0)
Conflict of interest statement: The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article. This study was funded by grants from the Science and Technology Projects of Hainan province (2015SF16); Technological Innovation Foundation of the PLA General Hospital (14KMM37); Medical and Technical Innovation Project, Sanya, Hainan Province (2014YW31); Health Industry Research Project of Hainan Province (14A210218); Natural Science Foundation of Hainan Province (20168362); National Natural Science Foundation of China (81271515); and the Key Research and Development Project of Hainan Province (ZDYF2016118). The sponsors had no role in the design or conduct of this research.