Application of augmented reality technology in the surgery of skull base tumor and cerebrovascular disease

Background Neurosurgery developed rapidly with technology advancing. Concept of digit⁃intelligent neurosurgery becomes mature and augmented reality (AR) technology shows great potential in future neurosurgical operations. The feasibility and applicability of AR assisted technology is currently the most important topic in clinical research. Methods Four cases engaged from January to December 2024 in Department of Neurosurgery of Beijing Tsinghua Changgung Hospital with vestibular schwannoma (one case), intracranial aneurysm (2 cases) and subclavian artery (SA) occlusion caused vertebral artery steal syndrome (one case) have been conducted tumor resection, internal carotid artery (ICA)⁃posterior communicating artery (PCoA) aneurysm clipping and common carotid artery (CCA)⁃SA bypass, respectively. Using presurgical imaging data⁃based Surgical AR reconstruction on the HoloLens 2 platform, preoperative planning, surgical simulation, and intraoperative display were conducted. These were then compared with surgical practices and postoperative imaging data to qualitatively evaluate their effectiveness in assisting neurosurgery. Results 1) Vestibular schwannoma resection: compared to the preoperative AR assisted simulation, we fully replicated the procedures of retrosigmoid approach craniotomy, removal of the posterior wall of internal auditory canal, and the exposure and removal of the internal auditory canal tumor during surgical practice. Facial nerve function was preserved intact during the surgery and reached House⁃Brackmann grade Ⅰ , but effective hearing was not preserved. Postoperative imaging data showed non ⁃ significant difference compared to preoperative simulation and surgical practice. The modified Rankin Scale (mRS) assessed postoperatively was 2. 2) ICA⁃PCoA aneurysm clipping: compared to the presurgical AR assistance, we fully replicate the procedures of lateral supraorbital craniotomy, removal of anterior clinoid process and the exposure and clipping of the neck of aneurysm. Postoperative imaging data showed non⁃significant difference compared to preoperative simulation. Postoperatively symptoms such as eye pain, ptosis, and double visian were completely relieved and the mRS was 0 after 6 months. 3) Basilar artery apex aneurysm clipping: based on preoperative simulation, we opted for the orbito⁃zygomatic approach during surgery to provide full exposure of the aneurysm neck and direct visualization of the bilateral P1 segment of posterior cerebral artery (PCA), offering better safety compared to the subtemporal approach. In surgical practice, lateral sulcus was separated, basilar artery and aneurysm was exposed and clipped via carotid spaces. Postoperatively occlomoter nerve was well recovered mRS was 0 after 6 months. 4) CCA⁃SA bypass: critical muscles and vessels on the neck were located intraoperatively on the body surface with AR assistance. CCA and SA were fully exposed and artificial vessel was anastomosed. Postoperative CTA 3D reconstruction suggested the blood flow was patent. The dizziness did not recur, and the blood pressure in the upper limb on the affected side returned to normal. Postoperative mRS was 0 after 6 months. Conclusions The application of AR technology in neurosurgical procedures allows for preoperative planning, surgical simulation, and intraoperative display. It aids young surgeons in quickly understanding complex anatomical structures and shortens the learning curve, holding significant clinical value and promising application prospects.