VentroAR: an augmented reality platform for ventriculostomy using the Microsoft HoloLens

Freehand ventriculostomy is one of the most common neurosurgical procedures performed when cerebrospinal fluid increases in the ventricular system causing an increase in intracranial pressure. In freehand ventriculostomy, surgeons use anatomical landmarks to determine where to make a burr hole on the skull and insert a catheter inside the brain to drain cerebrospinal fluid. Often, several insertion attempts are required to successfully reach the ventricular target. Misplacement of catheter in ventriculostomy can cause complications such as infection, haemorrhage and longer hospitalisations. In this paper, we introduce an augmented reality pipeline using an optical tracking device and HoloLens to help surgeons locate ventricles more easily and reduce the risk associated with this procedure. The proposed system, VentroAR, was evaluated in a user study with 15 subjects. We found that the gesture-based registration accuracy was on average 10.75 mm and targeting accuracy was 10.64 mm. Although the HoloLens shows promise in terms of workflow and ease of use, more work needs to be done to improve accuracy for clinical acceptance.