Augmented reality for epilepsy surgery: Examining usability and efficacy in presurgical planning

Objective: The aim of this paper was to visualize 3-dimensional (3-D) brain and electrode placement data for epilepsy surgery within an augmented reality (AR) environment using a wearable headset, with the ultimate goal of enhancing presurgical planning for epilepsy surgery and understanding the efficiency and utility of such a program in a clinical setting. The evaluation process for surgical intervention in epilepsy cases involves a series of extensive tests, including EEG, MRI, PET, SPECT, and fMRI. A second phase of assessment incorporates the placement of depth electrodes within the brain to record seizure activity. The culmination of these complex data is presented to the neurosurgery team for the formulation of a surgical plan. However, the conventional presentation of intricate 3-D data on a 2-dimensional (2-D) computer monitor limits the ability to convey the full depth and detail of the patient's brain and electrode data. Methods: Five images were selected from a cohort of patients being evaluated for refractory epilepsy at a single center. Their presurgical MRI scans, SEEG electrode data, and CT scans were utilized to generate 3-D AR representations, which were uploaded onto the Duke Augmented Reality Epilepsy Planner (AREP), an application on the Microsoft HoloLens 2. A survey was administered to faculty members to determine usability and effectiveness of the application. Results: AR images of the brain and electrodes, allowing resizing, movement, and rotation, with distinct colors differentiating tissue and electrodes, were presented in AREP. The application featured an interactive image manipulation menu. Survey results from 18 faculty members regarding seven questions indicated that AREP was user-friendly and can be effective in presurgical planning moving forward. Significance: AR integration of medical imaging data for epilepsy surgery transcends its role as a communication tool. It provides a deeper representation of surgical anatomy and serves as a valuable method for fostering communication among clinicians.