Clinical Application of a Novel Augmented Reality Navigation System for Chronic Subdural Hematoma Surgery Using a Single Quick Response Code Marker as a Tracking Target: Technical Note.

BACKGROUND

Augmented reality (AR) can support neurosurgical procedures by integrating 3-dimensional (3D) images into real-world views to help anatomical understanding. However, current systems are cumbersome and not attractive for trainees. Studies on wearable AR devices show promise but need further refinement.

METHODS

This preliminary report assesses a novel augmented reality navigation system (ARnavS) using a simultaneous localization and mapping algorithm provided with the Vuforia SDK and a quick response code. The system was applied to burr-hole surgeries in 10 cases of chronic subdural hematoma to evaluate its convenience and accuracy.

RESULTS

Ten patients with 11 hematomas underwent burr-hole surgeries using ARnavS. The system was effective without equipment issues, with an average registration time of 2.6 minutes. Discrepancy between planned and actual burr-hole locations was 3.5 mm. Skin incisions avoided 3D image of the superficial temporal artery, with no superficial temporal artery damage in any case. The mean surgical time was 37.1 minutes, and no severe postoperative bleeding occurred.

CONCLUSIONS

Our ARnavS for burr-hole surgery in chronic subdural hematoma offers good 3D imaging with quick registration. It provided surgeons with better anatomical comprehension, helping to avoid injury to critical structures. Unlike conventional systems, ARnavS allows direct visualization of 3D graphics in the surgical field, beneficial for less-experienced neurosurgeons and medical students. While further studies are needed, the AR navigation system with simultaneous localization and mapping algorithm and quick response code showed precise intraoperative 3D imaging with sufficient accuracy after quick registration. While further studies are needed, it has demonstrated practical usefulness in clinical neurosurgical procedures.