Dataset Information

Navigation-Linked Heads-Up Display in Intracranial Surgery: Early Experience.

ABSTRACT:

Background

The use of intraoperative navigation during microscope cases can be limited when attention needs to be divided between the operative field and the navigation screens. Heads-up display (HUD), also referred to as augmented reality, permits visualization of navigation information during surgery workflow.

Objective

To detail our initial experience with HUD.

Methods

We retrospectively reviewed patients who underwent HUD-assisted surgery from April 2016 through April 2017. All lesions were assessed for accuracy and those from the latter half of the study were assessed for utility.

Results

Seventy-nine patients with 84 pathologies were included. Pathologies included aneurysms (14), arteriovenous malformations (6), cavernous malformations (5), intracranial stenosis (3), meningiomas (27), metastasis (4), craniopharygniomas (4), gliomas (4), schwannomas (3), epidermoid/dermoids (3), pituitary adenomas (2) hemangioblastoma (2), choroid plexus papilloma (1), lymphoma (1), osteoblastoma (1), clival chordoma (1), cerebrospinal fluid leak (1), abscess (1), and a cerebellopontine angle Teflon granuloma (1). Fifty-nine lesions were deep and 25 were superficial. Structures identified included the lesion (81), vessels (48), and nerves/brain tissue (31). Accuracy was deemed excellent (71.4%), good (20.2%), or poor (8.3%). Deep lesions were less likely to have excellent accuracy (P = .029). HUD was used during bed/head positioning (50.0%), skin incision (17.3%), craniotomy (23.1%), dural opening (26.9%), corticectomy (13.5%), arachnoid opening (36.5%), and intracranial drilling (13.5%). HUD was deactivated at some point during the surgery in 59.6% of cases. There were no complications related to HUD use.

Conclusion

HUD can be safely used for a wide variety of vascular and oncologic intracranial pathologies and can be utilized during multiple stages of surgery.

SUBMITTER: Mascitelli JR

PROVIDER: S-EPMC6047456 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Publications

Navigation-Linked Heads-Up Display in Intracranial Surgery: Early Experience.

Mascitelli Justin R JR Schlachter Leslie L Chartrain Alexander G AG Oemke Holly H Gilligan Jeffrey J Costa Anthony B AB Shrivastava Raj K RK Bederson Joshua B JB

Operative neurosurgery (Hagerstown, Md.) 20180801 2

<h4>Background</h4>The use of intraoperative navigation during microscope cases can be limited when attention needs to be divided between the operative field and the navigation screens. Heads-up display (HUD), also referred to as augmented reality, permits visualization of navigation information during surgery workflow.<h4>Objective</h4>To detail our initial experience with HUD.<h4>Methods</h4>We retrospectively reviewed patients who underwent HUD-assisted surgery from April 2016 through April 2 ...[more]

PMID: 29040677

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Project description:ObjectivesFrontline insights into care delivery correlate with patients' clinical outcomes. These outcomes might be improved through near-real time identification and mitigation of staff concerns. We evaluated the effects of a prospective frontline surveillance system on patient and team outcomes.DesignProspective, stepped wedge, non-randomised, cluster controlled trial; prespecified per protocol analysis for high-fidelity intervention delivery.ParticipantsSeven interdisciplinary medical ward teams from two hospitals in the UK.InterventionProspective clinical team surveillance (PCTS): structured daily interdisciplinary briefings to capture staff concerns, with organisational facilitation and feedback.Main measuresThe primary outcome was excess length of stay (eLOS): an admission more than 24 hours above the local average for comparable patients. Secondary outcomes included safety and teamwork climates, and incident reporting. Mixed-effects models adjusted for time effects, age, comorbidity, palliation status and ward admissions. Safety and teamwork climates were measured with the Safety Attitudes Questionnaire. High-fidelity PCTS delivery comprised high engagement and high briefing frequency.ResultsImplementation fidelity was variable, both in briefing frequency (median 80% working days/month, IQR 65%-90%) and engagement (median 70 issues/ward/month, IQR 34-113). 1714/6518 (26.3%) intervention admissions had eLOS versus 1279/4927 (26.0%) control admissions, an absolute risk increase of 0.3%. PCTS increased eLOS in the adjusted intention-to-treat model (OR 1.32, 95% CI 1.10 to 1.58, p=0.003). Conversely, high-fidelity PCTS reduced eLOS (OR 0.79, 95% CI 0.67 to 0.94, p=0.006). High-fidelity PCTS also increased total, high-yield and non-nurse incident reports (incidence rate ratios 1.28-1.79, all p<0.002). Sustained PCTS significantly improved safety and teamwork climates over time.ConclusionsThis study highlighted the potential benefits and pitfalls of ward-level interdisciplinary interventions. While these interventions can improve care delivery in complex, fluid environments, the manner of their implementation is paramount. Suboptimal implementation may have an unexpectedly negative impact on performance.Trial registration numberISRCTN 34806867 (http://www.isrctn.com/ISRCTN34806867).

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Dataset Information

Navigation-Linked Heads-Up Display in Intracranial Surgery: Early Experience.

Background

Objective

Methods

Results

Conclusion

Publications

Navigation-Linked Heads-Up Display in Intracranial Surgery: Early Experience.

Similar Datasets

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