Augmented reality–assisted microsurgical resection of brain arteriovenous malformations: illustrative case

Lea Scherschinski; Ian T. McNeill; Leslie Schlachter; William H. Shuman; Holly Oemke; Kurt A. Yaeger; Joshua B. Bederson

doi:10.3171/CASE21135

Augmented reality–assisted microsurgical resection of brain arteriovenous malformations: illustrative case

Lea Scherschinski, Ian T. McNeill, Leslie Schlachter, William H. Shuman, Holly Oemke, Kurt A. Yaeger, Joshua B. Bederson

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

BACKGROUND Arteriovenous malformations (AVMs) of the brain are vessel conglomerates of feeding arteries and draining veins that carry a risk of spontaneous and intraoperative rupture. Augmented reality (AR)-assisted neuronavigation permits continuous, real-time, updated visualization of navigation information through a heads-up display, thereby potentially improving the safety of surgical resection of AVMs. OBSERVATIONS The authors report a case of a 37-year-old female presenting with a 2-year history of recurrent falls due to intermittent right-sided weakness and increasing clumsiness in the right upper extremity. Magnetic resonance imaging, magnetic resonance angiography, and cerebral angiography of the brain revealed a left parietal Spetzler-Martin grade III AVM. After endovascular embolization of the AVM, microsurgical resection using an AR-assisted neuronavigation system was performed. Postoperative angiography confirmed complete obliteration of arteriovenous shunting. The postsurgical course was unremarkable, and the patient remains in excellent health. LESSONS Our case describes the operative setup and intraoperative employment of AR-assisted neuronavigation for AVM resection. Application of this technology may improve workflow and enhance patient safety.

Original language	English (US)
Article number	CASE21135
Journal	Journal of Neurosurgery: Case Lessons
Volume	3
Issue number	25
DOIs	https://doi.org/10.3171/CASE21135
State	Published - Jun 2022

Keywords

arteriovenous malformation
augmented reality
AVM
image-guided surgery
neuronavigation
virtual reality

ASJC Scopus subject areas

Clinical Neurology
Surgery

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10.3171/CASE21135

Cite this

@article{7ebcd2e581544ed2b99dbf3d94d75283,

title = "Augmented reality–assisted microsurgical resection of brain arteriovenous malformations: illustrative case",

abstract = "BACKGROUND Arteriovenous malformations (AVMs) of the brain are vessel conglomerates of feeding arteries and draining veins that carry a risk of spontaneous and intraoperative rupture. Augmented reality (AR)-assisted neuronavigation permits continuous, real-time, updated visualization of navigation information through a heads-up display, thereby potentially improving the safety of surgical resection of AVMs. OBSERVATIONS The authors report a case of a 37-year-old female presenting with a 2-year history of recurrent falls due to intermittent right-sided weakness and increasing clumsiness in the right upper extremity. Magnetic resonance imaging, magnetic resonance angiography, and cerebral angiography of the brain revealed a left parietal Spetzler-Martin grade III AVM. After endovascular embolization of the AVM, microsurgical resection using an AR-assisted neuronavigation system was performed. Postoperative angiography confirmed complete obliteration of arteriovenous shunting. The postsurgical course was unremarkable, and the patient remains in excellent health. LESSONS Our case describes the operative setup and intraoperative employment of AR-assisted neuronavigation for AVM resection. Application of this technology may improve workflow and enhance patient safety.",

keywords = "arteriovenous malformation, augmented reality, AVM, image-guided surgery, neuronavigation, virtual reality",

author = "Lea Scherschinski and McNeill, {Ian T.} and Leslie Schlachter and Shuman, {William H.} and Holly Oemke and Yaeger, {Kurt A.} and Bederson, {Joshua B.}",

note = "Funding Information: We thank Laura Salgado-Lopez, MD, for assistance with manuscript editing. We acknowledge support from the German Research Foundation (DFG) and the Open Access Publication Fund of Charit{\'e}– Universit€atsmedizin Berlin. Funding Information: We thank Laura Salgado-Lopez, MD, for assistance with manuscript editing. We acknowledge support from the German Research Foundation (DFG) and the Open Access Publication Fund of Charite – Universit€atsmedizin Berlin. Publisher Copyright: {\textcopyright} 2022 The authors, CC BY-NC-ND 4.0.",

year = "2022",

month = jun,

doi = "10.3171/CASE21135",

language = "English (US)",

volume = "3",

journal = "Journal of Neurosurgery: Case Lessons",

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publisher = "American Association of Neurological Surgeons",

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T1 - Augmented reality–assisted microsurgical resection of brain arteriovenous malformations

T2 - illustrative case

AU - Scherschinski, Lea

AU - McNeill, Ian T.

AU - Schlachter, Leslie

AU - Shuman, William H.

AU - Oemke, Holly

AU - Yaeger, Kurt A.

AU - Bederson, Joshua B.

N1 - Funding Information: We thank Laura Salgado-Lopez, MD, for assistance with manuscript editing. We acknowledge support from the German Research Foundation (DFG) and the Open Access Publication Fund of Charité– Universit€atsmedizin Berlin. Funding Information: We thank Laura Salgado-Lopez, MD, for assistance with manuscript editing. We acknowledge support from the German Research Foundation (DFG) and the Open Access Publication Fund of Charite – Universit€atsmedizin Berlin. Publisher Copyright: © 2022 The authors, CC BY-NC-ND 4.0.

PY - 2022/6

Y1 - 2022/6

N2 - BACKGROUND Arteriovenous malformations (AVMs) of the brain are vessel conglomerates of feeding arteries and draining veins that carry a risk of spontaneous and intraoperative rupture. Augmented reality (AR)-assisted neuronavigation permits continuous, real-time, updated visualization of navigation information through a heads-up display, thereby potentially improving the safety of surgical resection of AVMs. OBSERVATIONS The authors report a case of a 37-year-old female presenting with a 2-year history of recurrent falls due to intermittent right-sided weakness and increasing clumsiness in the right upper extremity. Magnetic resonance imaging, magnetic resonance angiography, and cerebral angiography of the brain revealed a left parietal Spetzler-Martin grade III AVM. After endovascular embolization of the AVM, microsurgical resection using an AR-assisted neuronavigation system was performed. Postoperative angiography confirmed complete obliteration of arteriovenous shunting. The postsurgical course was unremarkable, and the patient remains in excellent health. LESSONS Our case describes the operative setup and intraoperative employment of AR-assisted neuronavigation for AVM resection. Application of this technology may improve workflow and enhance patient safety.

AB - BACKGROUND Arteriovenous malformations (AVMs) of the brain are vessel conglomerates of feeding arteries and draining veins that carry a risk of spontaneous and intraoperative rupture. Augmented reality (AR)-assisted neuronavigation permits continuous, real-time, updated visualization of navigation information through a heads-up display, thereby potentially improving the safety of surgical resection of AVMs. OBSERVATIONS The authors report a case of a 37-year-old female presenting with a 2-year history of recurrent falls due to intermittent right-sided weakness and increasing clumsiness in the right upper extremity. Magnetic resonance imaging, magnetic resonance angiography, and cerebral angiography of the brain revealed a left parietal Spetzler-Martin grade III AVM. After endovascular embolization of the AVM, microsurgical resection using an AR-assisted neuronavigation system was performed. Postoperative angiography confirmed complete obliteration of arteriovenous shunting. The postsurgical course was unremarkable, and the patient remains in excellent health. LESSONS Our case describes the operative setup and intraoperative employment of AR-assisted neuronavigation for AVM resection. Application of this technology may improve workflow and enhance patient safety.

KW - arteriovenous malformation

KW - augmented reality

KW - AVM

KW - image-guided surgery

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Augmented reality–assisted microsurgical resection of brain arteriovenous malformations: illustrative case

Abstract

Keywords

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