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The quality of neurosurgical planning can become compromised by soft tissue deformations that occur during surgery (i.e., brain shift). Conventional image guidance systems do not consider these intraoperative changes. In recent efforts, model based strategies have been developed to estimate surgical load displacements and modify the patient’s data intraoperatively to account for brain shift. While the efficacy of the model has been previously established, there is also an opportunity to further assist surgical planning with this pipeline. To address this, a mobile application designed for an Android tablet was developed to display simulated brain shifts that would occur during brain tumor surgery. The application has two primary functions to facilitate planning: a patient positioning mode and a simulation mode. The patient positioning mode allows the neurosurgeon to load the patient’s preoperative MR data and create a surgical plan (i.e., head orientation and craniotomy location) for the procedure. The simulation mode then displays both the preoperative data and the model predicted brain shift as a function of the specified orientation from the patient positioning mode. Additionally, to account for positional variations between planning and procedural implementation, the simulation mode also displays solutions with additional perturbations to the planned positioning to estimate shift possibilities. To assess the simulation mode prototype, practicing neurosurgeons were provided a prototype demonstration and interviews were performed to evaluate efficacy and design. Due to computational rendering and 3D rotation shortcomings based on clinical feedback, the prototype was redesigned into a full mixed reality simulation app on the Microsoft HoloLens. Preliminary survey responses show that the prototype could be an impactful surgical planning tool, especially among neurosurgeons with less experience.
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