The utility of augmented reality in retrosigmoid craniotomies: several innovations

Objective: During retrosigmoid craniotomy, it is vital that the transverse-sigmoid sinus junction (TSSJ) is positioned correctly, as it improves surgical efficiency and prevents complications. To explore a clinical application scenario of mobile AR-based navigation system (MARNS), the authors examined whether it can be used to position the TSSJ during craniotomy in the retrosigmoid approach and summarize the experience. Methods: : Seven patients who underwent retrosigmoid craniotomy had their TSSJ located by MARNS. The surgical incision and skull "keyhole" for drilling were determined separately based on the projections of TSSJ on the 3D model displayed by MARNS. As indicators of effectiveness, this method was assessed via matching error, positioning time, integrity of the bone flap, and incidence of TSS injury, as well as other complications. Results: : In all cases, the inner edges of TSSJ were accurately located and exposed, and the bone flaps formed and remained almost intact. In terms of matching error and positioning time, MARNS had a higher matching error than neuro-navigation system(NNS) (t = 3.897, p = 0.0021), but took a shorter time to location (t = 5.005, p = 0.0003). Conclusion: In this study, MARNS was innovative in tattooed landmarks, coupled with digital surgical design and improved surgical skills, leading to a successful retrosigmoid craniotomy. This system offers convenience, accuracy, cost-effectiveness, and reliability for the planning of neurosurgical procedures.