Image-guidance in endoscopic pituitary surgery: an in-silico study of errors involved in tracker-based techniques

Frontiers in Surgery

Surgery

João Ramalhinho¹  Mobarakol Islam¹  Thomas Dowrick¹  Matthew J. Clarkson¹  Aure Enkaoua¹  Danyal Z. Khan²  James Booker²  Hani J. Marcus² 

[1] Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK;Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK;Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK;

关键词: augmented reality;    pituitary surgery;    computer-assisted surgery;    tracking;    neurosurgery;   

DOI  :  10.3389/fsurg.2023.1222859

 received in 2023-05-15, accepted in 2023-08-11,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundEndoscopic endonasal surgery is an established minimally invasive technique for resecting pituitary adenomas. However, understanding orientation and identifying critical neurovascular structures in this anatomically dense region can be challenging. In clinical practice, commercial navigation systems use a tracked pointer for guidance. Augmented Reality (AR) is an emerging technology used for surgical guidance. It can be tracker based or vision based, but neither is widely used in pituitary surgery.MethodsThis pre-clinical study aims to assess the accuracy of tracker-based navigation systems, including those that allow for AR. Two setups were used to conduct simulations: (1) the standard pointer setup, tracked by an infrared camera; and (2) the endoscope setup that allows for AR, using reflective markers on the end of the endoscope, tracked by infrared cameras. The error sources were estimated by calculating the Euclidean distance between a point’s true location and the point’s location after passing it through the noisy system. A phantom study was then conducted to verify the in-silico simulation results and show a working example of image-based navigation errors in current methodologies.ResultsThe errors of the tracked pointer and tracked endoscope simulations were 1.7 and 2.5 mm respectively. The phantom study showed errors of 2.14 and 3.21 mm for the tracked pointer and tracked endoscope setups respectively.DiscussionIn pituitary surgery, precise neighboring structure identification is crucial for success. However, our simulations reveal that the errors of tracked approaches were too large to meet the fine error margins required for pituitary surgery. In order to achieve the required accuracy, we would need much more accurate tracking, better calibration and improved registration techniques.

【 授权许可】

Unknown   
© 2023 Enkaoua, Islam, Ramalhinho, Dowrick, Booker, Khan, Marcus and Clarkson.