Real time parallel intraoperative integration of endoscopic, microscopic, and navigation images: a proof of concept based on laboratory dissections

Abstract

Endoscope, microscope, and neuronavigation systems are integrated in neurosurgical procedures mainly by using a serial combination algorithm, where, the user must switch his/her field of view from one platform display to another. The integration of theses devices could be optimized by incorporating different displays into one viewing platform thus achieving a parallel combination. In this study, we investigated the feasibility and the applicability of parallel integration of microscopic, endoscopic, and neuronavigation images by real time displaying the endoscope and neuronavigation image datasets in the main operative microscope oculars. The proposed set-up was effective in displaying the three images dataset in an operationally actionable mode. Ergonomically, the ability of using the different image dataset without the need of taking the eyes off the microscope oculars did not disrupt the flow or the tempo of the operative procedure. However, new endoscopes specific to this application are recommended.

Keywords: endoscope; image-guided surgery; medical technology; microneurosurgery; skull base surgery.

Figure 1

General set-up of the BiOpix® system. (A) The system is positioned in a cart next to the microscope. (B) The red arrow indicates the main control screen, and the green arrow points to the secondary control screen.

Figure 2

The tip of the endoscope was navigated using the Stryker neuronavigation system.

Figure 3

(A, B) Subtemporal approach. Visualization of hard to see structures in the injected endoscopic image. (A) The area of the basilar artery between the origin of the superior cerebellar (*) and posterior cerebral artery (**) can be exposed and verified without cutting the tentorium. (B) The origin of cranial nerve III can be verified without cutting the tentorium.

Figure 4

Suboccipital retrosigmoid approach. The foramen of Luschka can be visualized and identified without any retraction. In this picture, we injected only the endoscope display in the microscope ocular.

Figure 5

Suboccipital retrosigmoid approach. The location and the size of the injected image can be changed. The endoscope and navigation feed are injected simultaneously in the microscope oculars.