Calvarial Biopsy Using Augmented Reality Technology: A Case Report and Technical Note

Abstract

Calvarial lesions are uncommonly encountered and are often a slow and progressive process. Biopsies of calvarial lesions can be uniquely challenging due to its proximity to critical structures. Augmented reality (AR) offers a potential alternative to computed tomography guidance that reduces radiation exposure and provides hands-free intraoperative guidance through complex and challenging surgical approaches. The patient is an 86-year-old female with significant past medical history of coronary heart disease. The patient underwent imaging which demonstrated a left parietal lytic skull lesion with extracranial extension. Using Surgical AR (Medivis, New York, New York, United States), a trajectory was planned centered on the lesion. Surgical AR was registered using point-to-point registration reliant on four anatomic fiducials. We used a ground truth, which is a bi-faced adhesive tag that measures 2 cm × 1 cm, with a QR code on each side that the Surgical AR system recognizes. This ground truth was placed on the patient's forehead, which linked to the registered holographic overlay. A small incision was made and after removal of a small portion of the overlying skull, multiple pieces of the lytic skull lesion were sampled. A specimen was obtained for frozen sectioning. Intra-operative pathology was consistent with metastatic carcinoma. Total surgical time was 35 minutes from incision to closure. The frameless AR navigation system successfully allowed accurate location, visualization, and biopsy of a calvarial lesion that had minimal surface landmarks. More so, this was completed without obscuring the surgical field or requiring time-consuming setup or registration.

Keywords

augmented reality (AR) - calvarial biopsy - hands-free - neuronavigation - guidance

Authors' Contributions

N.S., E.G.A., A.N.M., J.B., and C.H. were involved in the design and conception of this manuscript. N.S., S.B., M.K., R.S., A.T., S.A., M.R., N.M.K., L.C., and F.S. performed the literature review and compiled the primary manuscript. N.S., A.T., S.A., N.M.K., L.C., J.R.H., M.R., F.S., and S.P.C. collected and analyzed data. N.S., A.T., S.A., and E.G.A. compiled the figures and video. All authors critically revised the manuscript. All authors approved the manuscript as it is written.

Publikationsverlauf

Artikel online veröffentlicht:
21. Mai 2025

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