Microscope-based augmented reality assistance in keyhole retrosigmoid approach for microvascular decompression: a technical note.

BACKGROUND

The keyhole retrosigmoid approach for microvascular decompression (MVD) demands a high level of microsurgical precision. To improve procedural safety and accuracy, we evaluated the integration of microscope-based augmented reality (MAR) guidance into this approach.

METHODS

Three patients with classical trigeminal neuralgia and a clearly identifiable neurovascular conflict were included. Anatomical segmentations were performed using Brainlab Elements software (Brainlab AG, Munich, Germany), employing both automatic and semi-automatic tools. Intraoperatively, the Zeiss Kinevo 900 microscope (Carl Zeiss AG, Oberkochen, Germany), integrated with MAR navigation, was used. The system's reliability and usefulness were evaluated while performing MVD through the keyhole retrosigmoid approach.

RESULTS

MAR guidance improved surgical confidence and precision during craniotomy and cerebellar retractor placement. The integration of MAR proved reliable and easy to use intraoperatively.

CONCLUSIONS

MAR-assisted MVD via a keyhole retrosigmoid approach is feasible, straightforward to implement, and provides valuable intraoperative guidance. MAR may enhance procedural safety and confidence during MVD for trigeminal neuralgia.