In recent years, huge progress has been made in the management of brain tumors, due to the availability of imaging devices, which provide fundamental anatomical and pathological information not only for diagnostic purposes

Background: This report discusses the utility of a wearable augmented reality platform in neurosurgery for parasagittal and convexity en plaque meningiomas with bone flap removal and custom-made cranioplasty. Methods: A real patient with en plaque cranial vault meningioma with diffuse and extensive dural involvement, extracranial extension into the calvarium, and homogeneous contrast enhancement on gadolinium-enhanced T1-weighted MRI, was selected for this case study. A patient-specific manikin was designed starting with the segmentation of the patient’s preoperative MRI images to simulate a craniotomy procedure. Surgical planning was performed according to the segmented anatomy, and customized bone flaps were designed accordingly. During the surgical simulation stage, the VOSTARS head-mounted display was used to accurately display the planned craniotomy trajectory over the manikin skull. The precision of the craniotomy was assessed based on the evaluation of previously prepared custom-made bone flaps. Results: A bone flap with a radius 0.5 mm smaller than the radius of an ideal craniotomy fitted perfectly over the performed craniotomy, demonstrating an error of less than ±1 mm in the task execution. The results of this laboratory-based experiment suggest that the proposed augmented reality platform helps in simulating convexity en plaque meningioma resection and custom-made cranioplasty, as carefully planned in the preoperative phase. Conclusions: Augmented reality head-mounted displays have the potential to be a useful adjunct in tumor surgical resection, cranial vault lesion craniotomy and also skull base surgery, but more study with large series is needed.

In non-orthostereoscopic video see-through (VST) head-mounted displays (HMDs), the perception of the three-dimensional space is negatively altered by geometrical aberrations, which may lead to perceptual errors, problems of hand-eye coordination, and discomfort for the user. Parallax-free VST HMDs have been proposed, yet their embodiments are generally difficult to create. The present study investigates the guidelines for the development of non-orthostereoscopic VST HMDs capable of providing perceptually coherent augmentations for close-up views, hence specifically devoted to guide high-precision manual tasks. Our underlying rationale is that, under VST view, a perspective-preserving conversion of the camera frames is sufficient to restore the natural perception of the relative depths around a pre-defined working distance in non-orthostereoscopic VST HMDs. This perspective conversion needs to account for the geometry of the visor and the working distance. A simulation platform was designed to compare the on-image displacements between the direct view of the world and the perspective-corrected VST view, considering three different geometrical arrangements of cameras and displays. A user study with a custom-made VST HMD was then conducted to evaluate quantitatively and qualitatively which of the three configurations was the most effective in mitigating the impact of the geometrical aberrations around the reference distance. The results of the simulations and of the user study both proved that, in non-orthostereoscopic VST HMDs, display convergence can be prevented, as the perspective conversion of the camera frames is sufficient to restore the correct stereoscopic perception by the user in the peripersonal space.

In the context of a European project, we identified over 150 requirements for the development of an augmented reality (AR) head-mounted display (HMD) specifically tailored to support highly challenging manual surgical procedures. The requirements were established by surgeons from different specialties and by industrial players working in the surgical field who had strong commitments to the exploitation of this technology. Some of these requirements were specific to the project, while others can be seen as key requirements for the implementation of an efficient and reliable AR headset to be used to support manual activities in the peripersonal space. The aim of this work is to describe these ergonomic requirements that impact the mechanical design of the HMDs, the possible innovative solutions to these requirements, and how these solutions have been used to implement the AR headset in surgical navigation. We also report the results of a preliminary qualitative evaluation of the AR headset by three surgeons.

The growing interest in augmented reality applications has led to an in-depth look at the performance of head-mounted displays and their testing in numerous domains. Other devices for augmenting the real world with virtual information are presented less frequently and usually focus on the description of the device rather than on its performance analysis. This is the case of projected augmented reality, which, compared to head-worn AR displays, offers the advantages of being simultaneously accessible by multiple users whilst preserving user awareness of the environment and feeling of immersion. This work provides a general evaluation of a custom-made head-mounted projector for the aid of precision manual tasks through an experimental protocol designed for investigating spatial and temporal registration and their combination. The results of the tests show that the accuracy ($0.6\pm 0.1$ mm of spatial registration error) and motion-to-photon latency ($113\pm 12$ ms) make the proposed solution suitable for guiding precision tasks.