Department of Neurosurgery NYU Langone Health New York City, New York, United States
Introduction: Placement of an external ventricular drain (EVD) is a common neurosurgical procedure. Providers classically rely on external landmarks to guide blind placement of the catheter. Despite familiarity with the procedure, catheter misplacement occurs frequently and can result in complications. Augmented reality (AR) assistance in catheter placement may obviate much of this risk. Here we describe our early in-human experience using a proprietary AR navigation system, part of an ongoing prospective trial.
Methods: Patients were prospectively enrolled in an IRB approved study. The SurgicalAR platform (Medivis, New York, NY) which leverages the Microsoft HoloLens 2 headset was utilized to generate a cranial holographic projection from the immediate pre-procedural head CT. The navigation system along with specially designed frameless stereotaxy tools allowed dynamic catheter targeting while compensating for patient movement. After donning the HoloLens and following registration, the ipsilateral Foramen of Monro was chosen as the intended target, and the final site of burr hole placement was chosen as the entry point.
Results: Three different users performed AR-guided ventriculostomies on 3 consecutive patients at bedside. All 3 patients had suffered subarachnoid hemorrhage and were indicated for placement of an EVD for treatment of elevated intracranial pressure. An additional team member was present for the procedure in order to mitigate delays in the registration step, which was longest for our first attempt and subsequently decreased. Post-procedural cranial imaging showed the final position of the ventricular catheter to be in the ipsilateral Foramen of Monro in each case. There were no intraprocedural complications.
Conclusion : We report the first in-human experience with AR-guided ventriculostomies using the Medivis SurgicalAR platform and Microsoft HoloLens. The procedure appears to be reproducible and safe for novel users, and highly accurate in a real clinical setting. We plan to enroll 20 patients total in this ongoing prospective trial.
