Previous, current, and future stereotactic EEG techniques for localising epileptic foci

INTRODUCTION: Drug-resistant focal epilepsy presents a significant morbidity burden globally, and epilepsy surgery has been shown to be an effective treatment modality. Therefore, accurate identification of the epileptogenic zone for surgery is crucial, and in those with unclear noninvasive data, stereoencephalography is required. AREAS COVERED: This review covers the history and current practices in the field of intracranial EEG, particularly analyzing how stereotactic image-guidance, robot-assisted navigation, and improved imaging techniques have increased the accuracy, scope, and use of SEEG globally. EXPERT OPINION: We provide a perspective on the future directions in the field, reviewing improvements in predicting electrode bending, image acquisition, machine learning and artificial intelligence, advances in surgical planning and visualization software and hardware. We also see the development of EEG analysis tools based on machine learning algorithms that are likely to work synergistically with neurophysiology experts and improve the efficiency of EEG and SEEG analysis and 3D visualization. Improving computer-assisted planning to minimize manual input from the surgeon, and seamless integration into an ergonomic and adaptive operating theater, incorporating hybrid microscopes, virtual and augmented reality is likely to be a significant area of improvement in the near future

Image overlay surgery based on augmented reality : a systematic review

Acknowledgements We thank the staff of the Medical Library of the University of Aberdeen for their advice and Prof. Jennifer Cleland and Dr Jenny Gregory for discussion and support. This work was funded by the Roland Sutton Academic Trust (0053/R/17) and an Elphinstone PhD Scholarship from the University of Aberdeen.Postprin

Evaluation Metrics for Augmented Reality in Neurosurgical Preoperative Planning, Surgical Navigation, and Surgical Treatment Guidance: A Systematic Review

BACKGROUND AND OBJECTIVE: Recent years have shown an advancement in the development of augmented reality (AR) technologies for preoperative visualization, surgical navigation, and intraoperative guidance for neurosurgery. However, proving added value for AR in clinical practice is challenging, partly because of a lack of standardized evaluation metrics. We performed a systematic review to provide an overview of the reported evaluation metrics for AR technologies in neurosurgical practice and to establish a foundation for assessment and comparison of such technologies. METHODS: PubMed, Embase, and Cochrane were searched systematically for publications on assessment of AR for cranial neurosurgery on September 22, 2022. The findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: The systematic search yielded 830 publications; 114 were screened full text, and 80 were included for analysis. Among the included studies, 5% dealt with preoperative visualization using AR, with user perception as the most frequently reported metric. The majority (75%) researched AR technology for surgical navigation, with registration accuracy, clinical outcome, and time measurements as the most frequently reported metrics. In addition, 20% studied the use of AR for intraoperative guidance, with registration accuracy, task outcome, and user perception as the most frequently reported metrics. CONCLUSION: For quality benchmarking of AR technologies in neurosurgery, evaluation metrics should be specific to the risk profile and clinical objectives of the technology. A key focus should be on using validated questionnaires to assess user perception; ensuring clear and unambiguous reporting of registration accuracy, precision, robustness, and system stability; and accurately measuring task performance in clinical studies. We provided an overview suggesting which evaluation metrics to use per AR application and innovation phase, aiming to improve the assessment of added value of AR for neurosurgical practice and to facilitate the integration in the clinical workflow

Visualization, navigation, augmentation. The ever-changing perspective of the neurosurgeon

Introduction: The evolution of neurosurgery coincides with the evolution of visualization and navigation. Augmented reality technologies, with their ability to bring digital information into the real environment, have the potential to provide a new, revolutionary perspective to the neurosurgeon. Research question: To provide an overview on the historical and technical aspects of visualization and navigation in neurosurgery, and to provide a systematic review on augmented reality (AR) applications in neurosurgery. Material and methods: We provided an overview on the main historical milestones and technical features of visualization and navigation tools in neurosurgery. We systematically searched PubMed and Scopus databases for AR applications in neurosurgery and specifically discussed their relationship with current visualization and navigation systems, as well as main limitations. Results: The evolution of visualization in neurosurgery is embodied by four magnification systems: surgical loupes, endoscope, surgical microscope and more recently the exoscope, each presenting independent features in terms of magnification capabilities, eye-hand coordination and the possibility to implement additional functions. In regard to navigation, two independent systems have been developed: the frame-based and the frame-less systems. The most frequent application setting for AR is brain surgery (71.6%), specifically neuro-oncology (36.2%) and microscope-based (29.2%), even though in the majority of cases AR applications presented their own visualization supports (66%). Discussion and conclusions: The evolution of visualization and navigation in neurosurgery allowed for the development of more precise instruments; the development and clinical validation of AR applications, have the potential to be the next breakthrough, making surgeries safer, as well as improving surgical experience and reducing costs

Spatiotemporal Optimization of Intratumoural Electric Field Modulation for Cancer Therapy

The use of anti-cancer non-ablative electric fields is an expanding area of research that includes clinically available external devices for the treatment of glioblastoma (GBM), and a pre-clinical internal system called Intratumoural Modulation Therapy (IMT). IMT uses multiple electrodes implanted within the tumour to apply low intensity electric fields (~1 V/cm) focused on the target region, anywhere in the brain, with no externally visible devices. In this thesis, multi-electrode spatiotemporally dynamic IMT is investigated through computer simulation, numerical optimization, brain phantom and in vitro validation methods. These planning and validation strategies are hypothesized to improve tumour coverage with the necessary electric field and improving treatment efficiency through minimizing number of electrodes, power consumption, and manual planning time. The development of an IMT optimization algorithm that considers the placement of multiple electrodes, voltage amplitude and phase shift of input waveforms showed that human scale tumours are coverable with anti-cancer electric fields. Additionally, maximally separating the relative phase shifts of sinusoidal voltage waveforms applied to the electrodes, induces rotating electric fields that cover the tumour over time, with spatially homogeneous time averaged fields. A treatment planning system designed specifically for IMT considered optimizable electrode trajectories and patient images to create custom field plans for each patient, which was validated using robotic electrode implantation on a brain phantom. These custom fields can be optimized to conform to patient-specific tumour size, shape, or location. The efficacy of spatiotemporally dynamic fields was validated by developing a purpose-built in vitro device to deliver multi-electrode IMT to patient derived GBM cells. Cell viability was reduced when subjected to these rotating electric fields, supporting the optimality criteria derived analytically. The IMT optimization algorithm and planning system, supporting phantom validation and in vitro data, together with an accompanying planning system user guide support the move to clinical trials in the future. Overall, IMT technology has been advanced in this thesis to include patient-specific treatment planning optimization, a development that holds significance towards the future clinical implementation of IMT and treatment goals

Determination and quantitative evaluation of image-based registration accuracy for robotic neurosurgery

Stereotactic neurosurgical robots allow quick, accurate location of small targets within the brain, relying on accurate registration of preoperative MRI/CT images with patient and robot coordinate systems. Fiducial markers or a stereotactic frame are used as registration landmarks and the patient’s head is fixed in position. An image-based system could be quick, non-invasive and allow the head to be moved during surgery giving greater ease of access. Submillimetre surgical precision at the target point is required. An octant representation is utilized to investigate full region of interest (ROI) head registration using parts only, with registration performed using the Iterative Closest Point (ICP) algorithm. Use of two octants sequentially obtained a mean RMS distance of 0.813±0.026 mm; adding subsequent octants did not significantly improve performance. An RMS distance of 0.812±0.025 mm was obtained for three octants used simultaneously. ICP was compared with Coherent Point Drift, and 3D Normal Distribution Transform, with and without added or smoothed noise, and was least affected by starting position or noise added; a mean accuracy of 0.884±0.050 mm across ten noise levels and four starting positions was achieved, which was shown to translate to submillimetre accuracy at points within the head

Augmented Reality Assistance for Surgical Interventions using Optical See-Through Head-Mounted Displays

Augmented Reality (AR) offers an interactive user experience via enhancing the real world environment with computer-generated visual cues and other perceptual information. It has been applied to different applications, e.g. manufacturing, entertainment and healthcare, through different AR media. An Optical See-Through Head-Mounted Display (OST-HMD) is a specialized hardware for AR, where the computer-generated graphics can be overlaid directly onto the user's normal vision via optical combiners. Using OST-HMD for surgical intervention has many potential perceptual advantages. As a novel concept, many technical and clinical challenges exist for OST-HMD-based AR to be clinically useful, which motivates the work presented in this thesis. From the technical aspects, we first investigate the display calibration of OST-HMD, which is an indispensable procedure to create accurate AR overlay. We propose various methods to reduce the user-related error, improve robustness of the calibration, and remodel the calibration as a 3D-3D registration problem. Secondly, we devise methods and develop hardware prototype to increase the user's visual acuity of both real and virtual content through OST-HMD, to aid them in tasks that require high visual acuity, e.g. dental procedures. Thirdly, we investigate the occlusion caused by the OST-HMD hardware, which limits the user's peripheral vision. We propose to use alternative indicators to remind the user of unattended environment motion. From the clinical perspective, we identified many clinical use cases where OST-HMD-based AR is potentially helpful, developed applications integrated with current clinical systems, and conducted proof-of-concept evaluations. We first present a "virtual monitor'' for image-guided surgery. It can replace real radiology monitors in the operating room with easier user control and more flexibility in positioning. We evaluated the "virtual monitor'' for simulated percutaneous spine procedures. Secondly, we developed ARssist, an application for the bedside assistant in robotic surgery. The assistant can see the robotic instruments and endoscope within the patient body with ARssist. We evaluated the efficiency, safety and ergonomics of the assistant during two typical tasks: instrument insertion and manipulation. The performance for inexperienced users is significantly improved with ARssist, and for experienced users, the system significantly enhanced their confidence level. Lastly, we developed ARAMIS, which utilizes real-time 3D reconstruction and visualization to aid the laparoscopic surgeon. It demonstrates the concept of "X-ray see-through'' surgery. Our preliminary evaluation validated the application via a peg transfer task, and also showed significant improvement in hand-eye coordination. Overall, we have demonstrated that OST-HMD based AR application provides ergonomic improvements, e.g. hand-eye coordination. In challenging situations or for novice users, the improvements in ergonomic factors lead to improvement in task performance. With continuous effort as a community, optical see-through augmented reality technology will be a useful interventional aid in the near future

De animais a máquinas : humanos tecnicamente melhores nos imaginários de futuro da convergência tecnológica

Dissertação (mestrado)—Universidade de Brasília, Instituto de Ciências Sociais, Departamento de Sociologia, 2020.O tema desta investigação é discutir os imaginários sociais de ciência e tecnologia que emergem a partir da área da neuroengenharia, em sua relação com a Convergência Tecnológica de quatro disciplinas: Nanotecnologia, Biotecnologia, tecnologias da Informação e tecnologias Cognitivas - neurociências- (CT-NBIC). Estas áreas desenvolvem-se e são articuladas por meio de discursos que ressaltam o aprimoramento das capacidades físicas e cognitivas dos seres humanos, com o intuito de construir uma sociedade melhor por meio do progresso científico e tecnológico, nos limites das agendas de pesquisa e desenvolvimento (P&D). Objetivos: Os objetivos nesse cenário, são discutir as implicações éticas, econômicas, políticas e sociais deste modelo de sistema sociotécnico. Nos referimos, tanto as aplicações tecnológicas, quanto as consequências das mesmas na formação dos imaginários sociais, que tipo de relações se estabelecem e como são criadas dentro desse contexto. Conclusão: Concluímos na busca por refletir criticamente sobre as propostas de aprimoramento humano mediado pela tecnologia, que surgem enquanto parte da agenda da Convergência Tecnológica NBIC. No entanto, as propostas de melhoramento humano vão muito além de uma agenda de investigação. Há todo um quadro de referências filosóficas e políticas que defendem o aprimoramento da espécie, vertentes estas que se aliam a movimentos trans-humanistas e pós- humanistas, posições que são ao mesmo tempo éticas, políticas e econômicas. A partir de nossa análise, entendemos que ciência, tecnologia e política estão articuladas, em coprodução, em relação às expectativas de futuros que são esperados ou desejados. Ainda assim, acreditamos que há um espaço de diálogo possível, a partir do qual buscamos abrir propostas para o debate público sobre questões de ciência e tecnologia relacionadas ao aprimoramento da espécie humana.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)The subject of this research is to discuss the social imaginaries of science and technology that emerge from the area of neuroengineering in relation with the Technological Convergence of four disciplines: Nanotechnology, Biotechnology, Information technologies and Cognitive technologies -neurosciences- (CT-NBIC). These areas are developed and articulated through discourses that emphasize the enhancement of human physical and cognitive capacities, the intuition it is to build a better society, through the scientific and technological progress, at the limits of the research and development (R&D) agendas. Objectives: The objective in this scenery, is to discuss the ethic, economic, politic and social implications of this model of sociotechnical system. We refer about the technological applications and the consequences of them in the formation of social imaginaries as well as the kind of social relations that are created and established in this context. Conclusion: We conclude looking for critical reflections about the proposals of human enhancement mediated by the technology. That appear as a part of the NBIC technologies agenda. Even so, the proposals of human enhancement go beyond boundaries that an investigation agenda. There is a frame of philosophical and political references that defend the enhancement of the human beings. These currents that ally to the transhumanism and posthumanism movements, positions that are ethic, politic and economic at the same time. From our analysis, we understand that science, technology and politics are articulated, are in co-production, regarding the expected and desired futures. Even so, we believe that there is a space of possible dialog, from which we look to open proposals for the public discussion on questions of science and technology related to enhancement of human beings