03.04.2025

A pilot study from Belgium shows that augmented reality (AR) guidance significantly improves the accuracy and safety of bedside placement of external ventricular drains (EVDs) compared to the traditional freehand method.

Image: Brain scan to help with 3D anatomical data

To improve EVD placement, a headset-based AR navigation system was specifically designed specifically.

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Limitations of traditional neuronavigation

Conventional neuronavigation systems, typically used in the operating room, are hindered by size and lack of portability. According to the study authors, these systems also require “unintuitive mental transformations of 2D information on remote displays into 3D action at the patient, dividing attention between both.” In contrast, AR projects 3D anatomical data directly into the surgeon’s field of view.

AR headset-based navigation system

The AR solution developed for the study combines the Microsoft HoloLens II headset with custom-built surgical navigation software. Key components include:

Standalone functionality: All necessary neuronavigation components are integrated into the headset.

3D anatomical modeling: Preoperative imaging enables creation of a patient-specific 3D model, with key landmarks such as the foramen of Monro.

Infrared tracking: A reference frame is attached to the patient’s head for accurate positioning.

Real-time guidance: A tracked surgical drill receives continuous feedback on positional and angular deviation, using a color-coded system to confirm optimal alignment.

Improved outcomes in pilot study

The clinical validation included 11 patients undergoing AR-guided EVD placement and 11 treated with the freehand method.

Key findings:

Functional placement: Achieved in all AR-guided cases vs. 7 in the freehand group.

Optimal placement: Reached in 8 AR cases (including 2 slit ventricles) vs. 3 freehand.

Failed placement: None in the AR group, one in the freehand group.

Reinterventions required: 0 with AR vs. 4 with freehand technique.

“The reinterventions, along with the implied multitude of attempts, constituted the primary cause of all procedure-related complications in the freehand group,” the authors state.

They further note: “Although for some cases freehand placement might have been equally successful, the distinct improvement over the control group indicates that the freehand technique may not consistently yield straightforward results.”

Next steps

Encouraged by these results, the research team plans to conduct a multicenter randomized controlled trial. This next phase is scheduled to begin at the end of 2025 and aims to further evaluate the clinical benefits of AR navigation in neurosurgical procedures.

MEDICA-tradefair.com; Source: Wolters Kluwer Health

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