Augmented Reality as a Teaching Tool for Pediatric Brainstem Biopsy

Pediatric diffuse midline gliomas in the brainstem (bDMGs) are malignant primary brain neoplasms with poor prognosis. Conventional dogma cites that biopsy procedures have risks of devastating injury to the eloquent brainstem and have no direct benefit to affected patients. In recent years, the use of augmented reality (AR) adjuncts has demonstrated potential in providing excellent intraoperative three-dimensional (3D) visualization of intracranial structures. Put together, we hypothesize that the application of AR will be useful as a training tool for brainstem biopsy procedures. Anatomical models of bDMG tumors are created and uploaded to an AR application. The processed data is transferred into designated AR head-mounted devices. Briefly, individual 3D-rendered bDMG images are overlaid with an age-matched, life-sized child mannequin in prone position. A virtual stereotactic brain biopsy needle is deployed by the user into the lesion. At the end of the exercise, each user evaluates their trajectory of choice to assess its accuracy. Overall, the participants reported that the AR platform was useful in reviewing technical nuances for brainstem biopsy in a safe environment. This focused, proof-of-concept study adds to the growing body of literature that AR platforms demonstrate feasibility for neurosurgeons in the understanding of challenging operative neuroanatomy.