MICROSCOPY & IMAGING
AR technology gives the surgeon confi dence in what they are assesssing
NEUROSURGERY NEW ERA IN
Heads-up surgery: Dr Robert Ibe discusses augmented reality in operating microscopes for neurosurgical interventions
rain cancer is one of the most deeply feared diseases. Besides often killing with devastating speed, it can also profoundly aff ect the organ that most people associate with the mind and self, the seat of our emotions and fundamental controller of our bodies and behaviour. Glioma is the most common cancer that originates in the brain. It is a ‘primary’ rather than ‘metastatic’ brain tumour. Gliomas are more accurately described based on the type of cells from which the tumour originated, for example, glioblastomas, astrocytomas or oligodendrogliomas. T e most common primary brain tumour in adults is glioblastoma multiforme, which is also unfortunately the deadliest. Apart from management options to
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control the symptoms of the tumour, one treatment option is surgical intervention. However, brain surgery is notoriously diffi cult. T e benefi ts need to be carefully considered against the risks of such surgery, and even then, successful recovery can be slow. But innovations are constantly being developed in multiple paradigms and new approaches pioneered.
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One such example is how microscopy is becoming increasingly facilitative of exoscopic microsurgery, especially in neurosurgery and neurovascular surgery.
HEADS-UP SURGERY Traditional surgical microscopes employ binocular eye pieces that necessitate a heads-down approach to surgery. Although such binocular microscopes off er excellent image quality, magnifi cation and illumination while freeing up the surgeon’s hands, the heads- down approach means compromised ergonomics. Surgeons frequently need to adopt awkward body positions, which can put considerable strain on their necks and backs, especially if these positions are maintained for several hours during surgery. “Keyhole surgery”, as laparoscopic
surgery is often referred to in lay terms, redefi ned the fi eld of surgery, providing minimally invasive procedures, which reduced pain, incision size, wound complications and post-operative recovery and hospital stay. However, laparoscopy can also reduce the surgeon’s range
of movement through the incision, and depth perception due to the two- dimensional (2D) view. Similarly, endoscopes facilitate minimally invasive brain surgery. T ey off er superior ergonomics when used with a high-resolution camera and a high-defi nition screen, to give surgeons an in-depth view of the brain. But endoscopy also has some limitations, such as short focal length and the lack of true depth perception with 2D images. Endoscopes also need to be operated by the surgeon, thereby occupying one hand throughout the surgery. A new digital surgical microscope optimised for heads-up surgery, with the ability to incorporate augmented reality (AR) technologies to better inform surgeons in real-time, has been developed by Leica Microsystems to tackle these surgical challenges. T e ARveo digital AR microscope and how it is being used by neurosurgeons, such as Professor Dr Raphael Guzman from the University Hospital and Children’s Hospital in Basel, Switzerland, highlights how technological advances in the digital imaging quality of
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