title: Augmented reality in neurovascular surgery: feasibility and first uses in the operating room.
abstract: OBJECTIVE
  The aim of this report is to present a prototype augmented reality (AR) intra-operative brain imaging system. We present our experience of using this new neuronavigation system in neurovascular surgery and discuss the feasibility of this technology for aneurysms, arteriovenous malformations (AVMs), and arteriovenous fistulae (AVFs).
  
  
  METHODS
  We developed an augmented reality system that uses an external camera to capture the live view of the patient on the operating room table and to merge this view with pre-operative volume-rendered vessels. We have extensively tested the system in the laboratory and have used the system in four surgical cases: one aneurysm, two AVMs and one AVF case.
  
  
  RESULTS
  The developed AR neuronavigation system allows for precise patient-to-image registration and calibration of the camera, resulting in a well-aligned augmented reality view. Initial results suggest that augmented reality is useful for tailoring craniotomies, localizing vessels of interest, and planning resection corridors.
  
  
  CONCLUSIONS
  Augmented reality is a promising technology for neurovascular surgery. However, for more complex anomalies such as AVMs and AVFs, better visualization techniques that allow one to distinguish between arteries and veins and determine the absolute depth of a vessel of interest are needed.
authors.affiliation: McConnell Brain Imaging Centre, McGill University, Montreal, Canada. marta@bic.mni.mcgill.ca.
authors.forename: Marta
authors.initials: M
authors.lastname: Kersten-Oertel
authors.affiliation: McConnell Brain Imaging Centre, McGill University, Montreal, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Gerard
authors.affiliation: McConnell Brain Imaging Centre, McGill University, Montreal, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Drouin
authors.affiliation: Montreal Neurological Institute and Hospital, Montreal, Canada.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Mok
authors.affiliation: Montreal Neurological Institute and Hospital, Montreal, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Sirhan
authors.affiliation: Montreal Neurological Institute and Hospital, Montreal, Canada.
authors.forename: David S
authors.initials: DS
authors.lastname: Sinclair
authors.affiliation: McConnell Brain Imaging Centre, McGill University, Montreal, Canada.
authors.forename: D Louis
authors.initials: DL
authors.lastname: Collins
mesh_terms: D000293:Adolescent; D001164:Arteriovenous Fistula / Q000601:surgery*; D002533:Cerebral Angiography; D003399:Craniotomy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods; D009873:Operating Rooms; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000379:methods
keywords: Aneurysm; Arteriovenous fistulae; Arteriovenous malformations; Augmented reality; Image-guided surgery; Neurovascular surgery; Visualization