Endoscopic surgery of spontaneous supratentorial intracerebral hematoma assisted by virtual reality and augmented reality

Objective To study the feasibility and clinical effectiveness of endoscopic removal of spontaneous supratentorial hematoma assisted by virtual reality (VR) and augmented reality (AR). Methods A retrospective analysis was conducted with 36 patients with spontaneous supratentorial hematoma who were admitted to the neurosurgery department of PLA General Hospital from September 2014 to October 2015. Based on the hospital picture archiving and communication (PACS) system, three-dimensional visualization of the patients’ hematomas and head outlines were achieved assisted by VR. The technology of AR, used together with imaging fusion application (APP) on android-system cell phones, helped physicians design trajectory to of hematomas. A perforator and transparent sheath were used to set up a working channel for removal of hematomas with endoscopes. Post-operative CT was conducted one day after surgery and volumes of hematomas were calculated with the software of 3D-slicer. The parameters were documented including hematoma evacuation rate, operation time, intraoperative blood loss, preoperative and postoperative (1 week post surgery) scores based on the Glasgow Coma Scale (GCS). Results Successful punctures to reach hematomas were achieved with the assistance of VR and AR in call cases. The mean operation time and actual endoscopic operation time were 54.0±9.6 min and 33.0±7.2 min, respectively. The mean amount of blood loss during operation was 80.0±21.5 ml. None of the cases developed postoperative re-bleeding. The average evacuation rate was 95.4%. The mean preoperative GCS score was 6.7±1.6, which was significantly increased to 12.6±1.9 (P<0.01) graded 1 week post surgery. Conclusions The technologies of VR based on hospital PACS systems and AR based on cell phone APP could help precisely localize the intracerebral hematomas and select appropriate puncture trajectory. With a working channel established by transparent sheath, the endoscope could help achieve satisfactory removal of hematomas and improve the outcome. Key words: Cerebral hemorrhage; Neuroendoscopy; Visual reality; Treatment outcome