Auditory feedback during frameless image-guided surgery in a phantom model and initial clinical experience

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In this study the authors measured the effect of auditory feedback during image-guided surgery (IGS) in a phantom model and in a clinical setting. In the phantom setup, advanced IGS with complementary auditory feedback was compared with results obtained with 2 routine forms of IGS, either with an on-screen image display or with imageinjection via a microscope. The effect was measured by means of volumetric resection assessments. The authors also present their first clinical data concerning the effects of complementary auditory feedback on instrument handling during image-guided neurosurgery. When using image-injection through the microscope for navigation, however, resection quality was significantly worse. In the clinical portion of the study, the authors performed resections of cerebral mass lesions in 6 patients with the aid of auditory feedback. Instrument tip speeds were slightly (although significantly) influenced by this feedback during resection. Overall, the participating neurosurgeons reported that the auditory feedback helped in decision-making during resection without negatively influencing instrument use. Postoperative volumetric imaging studies revealed resection rates of ≥ 95% when IGS with auditory feedback was used. There was only a minor amount of brain shift, and postoperative resection volumes corresponded well with the preoperative intentions of the neurosurgeon. Although the results of phantom surgery with auditory feedback revealed no significant effect on resection quality or extent, auditory cues may help prevent damage to eloquent brain structures.

Abbreviations used in this paper: HUD = heads-up display; IGS = image-guided surgery.

Article Information

Address correspondence to: Peter A. Woerdeman, M.D., University Medical Center Utrecht (G03.124), Department of Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. email: p.a.

© AANS, except where prohibited by US copyright law."



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    Photographs of typical situations during the phantom experiments. Left: Phantom resection experiment using standard IGS techniques. Notice the surgeon's visual focus on the computer screen of the neuronavigation workstation. Right: Surgeon performing a phantom resection experiment using standard IGS and auditory feedback.

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    Screenshot of the logging of ultrasonic aspirator tip positions during an image-guided resection procedure of a lowgrade oligodendroglioma. The auditory feedback mode is active.

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    Postresection cross-sectional CT images (midsagittal) of the 12 floral foam blocks. The white lines indicate the outline of the target volume. The dashed white line represents the entrance of the resection cavity. In the area above this line, the floral foam was eroded by the ultrasonic aspirator shaft. Consequently, this volume was excluded from analysis.

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    Bar graph showing overall resection data of the 3 modes of IGS. Note the significant lower similarity and higher nonresected target volume in the IGS with HUD group.



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