Efficacy of a Novel Augmented Reality Navigation System Using 3D Computer Graphic Modeling in Endoscopic Transsphenoidal Surgery for Sellar and Parasellar Tumors

SIMPLE SUMMARY: In endoscopic transsphenoidal skull base surgery, it is often difficult to accurately determine the location of a tumor and its surroundings on imaging because the lesion remarkably displaces the geography of normal anatomic structures. We aimed to create a novel augmented reality (AR) navigation system that could compensate for this displacement effect. We created a precise three-dimensional computer graphic (3DCG) model that we superimposed on a visual image of the actual surgical field and displayed on a video monitor during endoscopic transsphenoidal surgery. Surgeons evaluated its efficacy using a five-point scale in 15 consecutive patients with sellar and parasellar tumors. The average score overall was 4.7 (95% confidence interval: 4.58–4.82), and the AR navigation system was considered as useful as or more useful than conventional navigation in certain patients. This system has the advantage of facilitating an immediate 3D understanding of the lesion and surrounding structures. ABSTRACT: In endoscopic transsphenoidal skull base surgery, knowledge of tumor location on imaging and the anatomic structures is required simultaneously. However, it is often difficult to accurately reconstruct the endoscopic vision of the surgical field from the pre-surgical radiographic images because the lesion remarkably displaces the geography of normal anatomic structures. We created a precise three-dimensional computer graphic model from preoperative radiographic data that was then superimposed on a visual image of the actual surgical field and displayed on a video monitor during endoscopic transsphenoidal surgery. We evaluated the efficacy of this augmented reality (AR) navigation system in 15 consecutive patients with sellar and parasellar tumors. The average score overall was 4.7 [95% confidence interval: 4.58–4.82], which indicates that the AR navigation system was as useful as or more useful than conventional navigation in certain patients. In two patients, AR navigation was assessed as less useful than conventional navigation because perception of the depth of the lesion was more difficult. The developed system was more useful than conventional navigation for facilitating an immediate three-dimensional understanding of the lesion and surrounding structures.