Fusion of augmented reality imaging with the endoscopic view for endonasal skull base surgery; a novel application for surgical navigation based on intraoperative cone beam computed tomography and optical tracking

Autoři: Marco Lai aff001;  Simon Skyrman aff003;  Caifeng Shan aff001;  Drazenko Babic aff001;  Robert Homan aff004;  Erik Edström aff003;  Oscar Persson aff003;  Gustav Burström aff003;  Adrian Elmi-Terander aff003;  Benno H. W. Hendriks aff001;  Peter H. N. de With aff002
Působiště autorů: Philips Research, Eindhoven, The Netherlands aff001;  Eindhoven University of Technology (TU/e), Eindhoven, The Netherlands aff002;  Department of Neurosurgery, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden aff003;  Philips Healthcare, Best, the Netherlands aff004;  Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands aff005
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227312



Surgical navigation is a well-established tool in endoscopic skull base surgery. However, navigational and endoscopic views are usually displayed on separate monitors, forcing the surgeon to focus on one or the other. Aiming to provide real-time integration of endoscopic and diagnostic imaging information, we present a new navigation technique based on augmented reality with fusion of intraoperative cone beam computed tomography (CBCT) on the endoscopic view. The aim of this study was to evaluate the accuracy of the method.

Material and methods

An augmented reality surgical navigation system (ARSN) with 3D CBCT capability was used. The navigation system incorporates an optical tracking system (OTS) with four video cameras embedded in the flat detector of the motorized C-arm. Intra-operative CBCT images were fused with the view of the surgical field obtained by the endoscope’s camera. Accuracy of CBCT image co-registration was tested using a custom-made grid with incorporated 3D spheres.


Co-registration of the CBCT image on the endoscopic view was performed. Accuracy of the overlay, measured as mean target registration error (TRE), was 0.55 mm with a standard deviation of 0.24 mm and with a median value of 0.51mm and interquartile range of 0.39˗˗0.68 mm.


We present a novel augmented reality surgical navigation system, with fusion of intraoperative CBCT on the endoscopic view. The system shows sub-millimeter accuracy.

Klíčová slova:

Cameras – Computed axial tomography – Endoscopic surgery – Endoscopy – Magnetic resonance imaging – Skull – Surgical and invasive medical procedures – Endoscopic plastic surgery


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