Augmented reality in cranial surgery: Surgical planning and maximal safety in resection of brain tumors via head-mounted fiber tractography.

Recent advancements in computer vision, enhanced augmented reality (AR) software and hardware are paving the way for AR to emerge as a promising and innovative tool for advancing and broadening neurosurgical pre-operative planning and intraoperative procedures. In this study, we describe the use of AR coupled with Magnetic Resonance (MR) and Diffusion Tensor Imaging (DTI) to map visual tracts around an occipital lesion, ensuring a safe resection without post-op complications. In a patient who underwent an elective craniotomy for the resection of an occipital brain tumor, preoperative MRI and Quicktome platform-based DTI MRI were uploaded onto the Medivis AR system. Pre-op and post-op fiber tractography was conducted using DSI Studio, and fiber volumes were compared. This technological setup was employed for pre-operative and intraoperative planning and further enhanced clinical decision-making for the actual tumor resection. The AR system and the preparation process are demonstrated via an illustrative video. The visual pathways were preserved during surgery consistent with the intraoperative visualization of these tracks on DTI using an AR headset. Clinically, postoperative visual field testing revealed no signs of visual loss. The volumes of the visual tracts were measured in preoperative and postoperative DTIs, showing that their volume was maintained. Our study highlights the feasibility in identifying preoperative tumor borders for incision planning and feasibility in preserving white matter tracts during tumor resection. AR FT-assisted surgery is safe and effective in planning the surgical approach for patients with brain tumors, thereby optimizing patient functional outcomes.