Virtual reality surgical planning

Virtual Reality OP-Planung

VizDexter2_0A neurosurgical procedure is a planned intervention into a highly complex three-dimensional space. A comprehensive understanding of the spatial relationships between individual anatomical and pathological structures is therefore imperative for successful surgery. As one of a few centers in the world we plan our neurosurgical operations in a computerized Virtual Reality (VR) environment. The Dextroscope (see left) enables precise work in a computergraphic three-dimensional workspace by reaching into the virtual structures resembling the way one interacts with real objects.

For this purpose, high resolution MRI and CT imaging series are three-dimensionally reconstructed and the individual anatomical structures realistically displayed. The best surgical approach is then simulated in a virtual 3D space. This allows planning of a minimally invasive surgical strategy, precisely tailored to the surgical target and the individual patient.

Simulation of clipping an upward pointing anterior communicating artery aneurysm

368_Supraorbital_1_f_r_Brosch_reSimulation of a right supraorbital approach for clipping of an aneurysm of the anterior communicating artery.
368_Supraorbital_2_f_r_Brosch_reSimulation of the magnified surgical view as seen through the operating microscope. The shape of the aneurysm, surrounding vessels and the strategy of clipping can be accurately anticipated.

Simulation of microvascular decompression in a case of trigeminal neuralgia

Simulation of a retrosigmoid craniotomy for microvascular decompression of the right trigeminal nerve. The ideal entry position of the surgical trajectory towards the surgical target structures is defined at the junction between the transverse and sigmoid sinus.  
Simulated intra-operative microsurgical view towards the neurovascular conflict. Note a loop of the superior cerebellar arterey (ACS) hidden behind the trigeminal nerve (x). A large petrosal vein (V) also lies in close contact with the nerve.
View towards the neurovascular conflict with the trigeminal nerve rendered transparent and hence exposing the full course of the conflicting artery. This allows precise planning of the microsurgical decompression.

Simulation of clipping a downward pointing anterior communicating artery aneurysm

A-com aneurysm – 3D simulation. The virtual image is projected on a 3D screen in the operating room.
A-com aneurysm microsurgically exposed via subfrontal approach. Note the irregularity of the aneurysm dome. 
A-com aneurysm clipped with one straight microclip.

Videos demonstrating various applications of the Dextroscope in microneurosurgery