Application of Augmented Reality Neuronavigation in Transnasal Endoscopic Skull Base Surgery

1. Research protocol The surgical AR neuroendoscopic system in this study mainly includes three core links: (1) virtual image or environmental modeling. AR systems use data derived from color or texture differences between anatomical structures in CT or MRI tomography, as well as whole-brain angiography, to complete a 3D reconstruction of a subsurface target in a computer. This process can also be done manually using the 3D-Slicer software. (2) Registration of virtual environment and real space. Registration technology is essential for AR systems, as it enables real-time tracking of anatomical structures in the endoscopic field of view. Registration can be done by a variety of means, such as the 3D Cartesian system, which is based on framing technology, which can determine the position and attitude of the imaging device, while also allowing the virtual environment to make rapid changes and register when the position changes in the real world. Or use frameless registration to register virtual match points with known anatomical landmarks in real space. (3) The final demand is to combine the virtual environment with the real environment to display technology. It can be divided into head-mounted display (HMD), enhanced external display, enhanced optical system, enhanced window display and image projection. Using HMDs to overlay virtual environments with video feeds from real environments (video perspective). Utilize a simple, stand-alone screen as an enhanced display to display virtual content on a video originating from a neuroendoscope.

After the above links are successfully achieved, transnasal skull base surgery is performed using neuroendoscope with AR to achieve real-time tracking, accurately identify anatomical structures, and reduce the risk of neurovascular injury and complications in skull base surgery.

Subjects: About 100 cases of neuroendoscopic skull base surgery performed in the Department of Neurosurgery of the First Affiliated Hospital of Xiamen University, regardless of gender and age.

Inclusion Criteria: 1. Patients undergoing transnasal endoscopic skull base surgery in our department. 2. Thin-slice head MRI and CTA scans were performed before surgery. Exclusion Criteria: 1. Patients without clear preoperative imaging data. 2. Patients who do not agree to receive AR fusion neuroendoscopic assistance. 3. Patients with incomplete medical records.

Intervention: Participants were divided into two groups to undergo transnasal skull base surgery using common neuroendoscopy and neuroendoscopy infused with augmented reality technology and compared.