• Eiju Watanabe, Makoto Satoh, Takehiko Konno, Masahiro Hirai, and Takashi Yamaguchi.
• Department of Neurosurgery, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi, Japan. Electronic address: eijuwat@gmail.com.
• World Neurosurg. 2016 Mar 1; 87: 399-405.

IntroductionThe neuronavigator has become indispensable for brain surgery and works in the manner of point-to-point navigation. Because the positional information is indicated on a personal computer (PC) monitor, surgeons are required to rotate the dimension of the magnetic resonance imaging/computed tomography scans to match the surgical field. In addition, they must frequently alternate their gaze between the surgical field and the PC monitor.ObjectiveTo overcome these difficulties, we developed an augmented reality-based navigation system with whole-operation-room tracking.MethodsA tablet PC is used for visualization. The patient's head is captured by the back-face camera of the tablet. Three-dimensional images of intracranial structures are extracted from magnetic resonance imaging/computed tomography and are superimposed on the video image of the head. When viewed from various directions around the head, intracranial structures are displayed with corresponding angles as viewed from the camera direction, thus giving the surgeon the sensation of seeing through the head. Whole-operation-room tracking is realized using a VICON tracking system with 6 cameras.ResultsA phantom study showed a spatial resolution of about 1 mm. The present system was evaluated in 6 patients who underwent tumor resection surgery, and we showed that the system is useful for planning skin incisions as well as craniotomy and the localization of superficial tumors.ConclusionsThe main advantage of the present system is that it achieves volumetric navigation in contrast to conventional point-to-point navigation. It extends augmented reality images directly onto real surgical images, thus helping the surgeon to integrate these 2 dimensions intuitively.Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

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