# A markerless, real-time, augmented reality-based surgical navigation system for neurosurgical biopsies

## TL;DR

This paper introduces a markerless AR system for neurosurgical biopsies that provides real-time 3D guidance and shows promising accuracy compared to current methods.

## Contribution

A novel markerless AR-based navigation system for neurosurgery that achieves comparable accuracy to existing clinical standards.

## Key findings

- The proposed AR system achieved an average clinical error of 4.5 ± 2.2 mm for biopsy entry points.
- The system's accuracy meets the current gold standard for image-guided neuronavigation in both lab and clinical settings.

## Abstract

Neurosurgical biopsies require high accuracy and precision and are executed with image-guided surgical navigation. The current state-of-the-art techniques require markers, are displayed on a 2D screen, and have a time-consuming setup. We propose an AR-driven surgical navigation method that automatically projects a 3D virtual overlay onto a patient in real-time, without the use of any markers.

Baseline accuracy of the proposed system and the StealthStation S8 was measured on a 3D printed human head phantom in a lab-based setting. For the measurements in the operating room, seventeen participants who underwent a neurosurgical biopsy with the StealthStation S8 were included. Prior to the clinical procedure, our proposed markerless AR system provided an automated three-dimensional virtual overlay onto the patient to the surgeon. By measuring the difference in the planned biopsy trajectory between the state-of-the-art StealthStation S8 and our experimental system, a comparison was made between the two systems.

The average clinical error for the entry point of the proposed system was 4.5 ± 2.2 mm, which is lower than the total error of the current clinical gold standard found in literature.

The total error of the system proposed in this study reaches the gold standard for image-guided neuronavigation, in both lab-controlled and clinical settings. These initial results highlight the potential and advantages of AR over other methods, offering promising AR opportunities for future clinical applications.