Multimodal Localization Using Smartphone Augmented Reality Combined with Brain Surface Morphology for Surgical Removal of Supratentorial Lesions

Background: Augmented reality (AR) has been widely used in neurosurgery in recent years. The combination of AR and brain surface morphology for localization has not been reported. The aim of this work was to report the outcomes of combined method for locating supratentorial lesions in neurosurgery. Methods: After multimodal image registration, brain tissue, the lesion, and blood vessels were reconstructed using a three-dimensional Slicer. AR was conducted using a smartphone application named Persp three-dimensional to project intracranial lesions on the scalp. The incision and size of the craniotomy were designed according to the location of the lesions. After craniotomy, the lesions were precisely located using brain surface morphology. Three types of morphology were used to localize the lesions: 1) the morphology of sulci and gyri; 2) superficial cerebral veins; and 3) combination of both. Then, the lesions were resected. Postoperative magnetic resonance imaging confirmed the extent of the resection. Results: Of the 34 patients included in this study, 13 (38.2%) had gliomas, 15 (44.1%) had focal cortical dysplasia, and 6 (17.6%) had cavernous hemangiomas. The first type of morphology was used in 8 (23.5%) patients, the second type in 5 (14.7%), and the third in 21 (61.8%). In all cases, the lesions were accurately located and completely removed. No complications were recorded. Conclusions: AR combined with brain surface morphology could accurately locate lesions. This combined approach is convenient to use, and helpful for planning craniotomy and removing lesions.