Three-dimensional–printed marker–based augmented reality neuronavigation: a new neuronavigation technique

OBJECTIVE The aim of this study was to assess the precision and feasibility of 3D-printed marker–based augmented reality (AR) neurosurgical navigation and its use intraoperatively compared with optical tracking neuronavigation systems (OTNSs). METHODS Three-dimensional–printed markers for CT and MRI and intraoperative use were applied with mobile devices using an AR light detection and ranging (LIDAR) camera. The 3D segmentations of intracranial tumors were created with CT and MR images, and preoperative registration of the marker and pathology was performed. A patient-specific, surgeon-facilitated mobile application was developed, and a mobile device camera was used for neuronavigation with high accuracy, ease, and cost-effectiveness. After accuracy values were preliminarily assessed, this technique was used intraoperatively in 8 patients. RESULTS The mobile device LIDAR camera was found to successfully overlay images of virtual tumor segmentations according to the position of a 3D-printed marker. The targeting error that was measured ranged from 0.5 to 3.5 mm (mean 1.70 ± 1.02 mm, median 1.58 mm). The mean preoperative preparation time was 35.7 ± 5.56 minutes, which is longer than that for routine OTNSs, but the amount of time required for preoperative registration and the placement of the intraoperative marker was very brief compared with other neurosurgical navigation systems (mean 1.02 ± 0.3 minutes). CONCLUSIONS The 3D-printed marker–based AR neuronavigation system was a clinically feasible, highly precise, low-cost, and easy-to-use navigation technique. Three-dimensional segmentation of intracranial tumors was targeted on the brain and was clearly visualized from the skin incision to the end of surgery.