Does Stereo-endoscopy Improve Neurosurgical Targeting in 3rd Ventriculostomy?

Endoscopic third ventriculostomy is a minimally invasive surgical technique to treat hydrocephalus; a condition where patients suffer from excessive amounts of cerebrospinal fluid (CSF) in the ventricular system of their brain. This technique involves using a monocular endoscope to locate the third ventricle, where a hole can be made to drain excessive fluid. Since a monocular endoscope provides only a 2D view, it is difficult to make this perforation due to the lack of monocular cues and depth perception. In a previous study, we had investigated the use of a stereo-endoscope to allow neurosurgeons to locate and avoid hazardous areas on the surface of the third ventricle. In this paper, we extend our previous study by developing a new methodology to evaluate the targeting performance in piercing the hole in the membrane. We consider the accuracy of this surgical task and derive an index of performance for a task which does not have a well-defined position or width of target. Our performance metric is sensitive and can distinguish between experts and novices. We make use of this metric to demonstrate an objective learning curve on this task for each subject.