A Novel Augmented Reality Navigation System for Trigeminal Rhizotomy

Background: Augmented reality (AR) has emerged as a promising tool in the field of neurosurgery, particularly for procedures requiring high precision and spatial awareness. This study explored the application of AR in trigeminal rhizotomy for the treatment of trigeminal neuralgia (TN).

Methods: A cadaveric head was used for the study. A metallic target was placed in the Sella, at the location of the trigeminal nerve V3. The head was CT scanned and a 3D model of the cadaver, including the skull base, and target points was generated. A novel augmented reality system was used. The system uses an ultrafast fiducial-less registration process and operates entirely out of a 1.2-lb headset to register the 3D model onto the head displaying a trajectory from Hartl’s point, passing through the foramen ovale, to the target point. Additionally, the system performs real-time tracking the rhizotomy needle as it is inserted. Seven participants were included and were asked to insert the rhizotomy needle towards the target at V3. The skull base was exposed to allow for physical accuracy measurements after insertions were complete. The distance from the needle tip to the target was measured using a caliper. Additionally the time to complete the insertion and the number of passes were recorded.

Results: All participants were able to successful canulate the foramen ovale and access the target located at V3. The AR system demonstrated a remarkable accuracy of 0.93 ± 1.34 mm to the target. The average time to reach the target was 126.2 ± 41.8 seconds and required an average of 1.8 ± 0.93 passes, highlighting the efficiency of the AR-guided approach.

Conclusion: Through real-time visualization of 3D models and trajectories structures overlaid on the patient's head combined with needle tracking, the AR system enabled rapid and accurate targeting of the trigeminal nerve. The participants were able to identify the optimal entry points and paths for rhizotomy needle insertion. These results are promising as they suggest that AR may significantly decrease the reliance on fluoroscopy by offering a more intuitive smaller footprint guidance solution. Future research should focus on large-scale clinical trials to validate these findings and optimize AR systems for widespread clinical use.

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Artikel online veröffentlicht:
07. Februar 2025