title: Augmented reality in the surgery of cerebral aneurysms: a technical report.
abstract: BACKGROUND
  Augmented reality is the overlay of computer-generated images on real-world structures. It has previously been used for image guidance during surgical procedures, but it has never been used in the surgery of cerebral aneurysms.
  
  
  OBJECTIVE
  To report our experience of cerebral aneurysm surgery aided by augmented reality.
  
  
  METHODS
  Twenty-eight patients with 39 unruptured aneurysms were operated on in a prospective manner with augmented reality. Preoperative 3-dimensional image data sets (angio-magnetic resonance imaging, angio-computed tomography, and 3-dimensional digital subtraction angiography) were used to create virtual segmentations of patients' vessels, aneurysms, aneurysm necks, skulls, and heads. These images were injected intraoperatively into the eyepiece of the operating microscope. An example case of an unruptured posterior communicating artery aneurysm clipping is illustrated in a video.
  
  
  RESULTS
  The described operating procedure allowed continuous monitoring of the accuracy of patient registration with neuronavigation data and assisted in the performance of tailored surgical approaches and optimal clipping with minimized exposition.
  
  
  CONCLUSIONS
  Augmented reality may add to the performance of a minimally invasive approach, although further studies need to be performed to evaluate whether certain groups of aneurysms are more likely to benefit from it. Further technological development is required to improve its user friendliness.
authors.affiliation: Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cabrilo
authors.forename: Philippe
authors.initials: P
authors.lastname: Bijlenga
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000532:radiotherapy / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D015898:Tomography Scanners, X-Ray Computed; D014584:User-Computer Interface; D014656:Vascular Surgical Procedures