Intracranial minimally invasive procedures imply working in a restricted surgical corridor surrounded by critical structures, such as vessels and cranial nerves. Any damage to them may affect patient outcome. Neuronavigation systems may reduce the risk of such complications. In this study, the authors sought to compare standard neuronavigation (NV) and augmented reality (AR)–guided navigation with respect to the integrity of the perifocal structures during a neurosurgical approach using a novel model imitating intracranial vessels.

A custom-made box, containing crisscrossing hard metal wires, a hidden nail at its bottom, and a wooden top, was scanned, fused, and referenced for the purpose of the study. The metal wires and an aneurysm clip applier were connected to a controller, which counted the number of contacts between them. Twenty-three naive participants were asked to 1) use NV to define an optimal entry point on the top, perform the smallest craniotomy possible on the wooden top, and to use a surgical microscope when placing a clip on the nail without touching the metal wires; and 2) use AR to preoperatively define an ideal trajectory, navigate the surgical microscope, and then perform the same task. The primary outcome was the number of contacts made between the metal wires and the clip applier. Secondary outcomes were craniotomy size, and trust in NV and AR to help avoid touching the metal wires, as assessed by a 9-level Likert scale.

The median number of contacts tended to be lower with the use of AR than with NV (AR, median 1 [Q1: 1, Q3: 2]; NV, median 3 [Q1: 1, Q3: 6]; p = 0.074). The size of the target-oriented craniotomy was significantly lower with the use of AR compared with NV (AR, median 4.91 cm2 [Q1: 4.71 cm2, Q3: 7.55 cm2]; and NV, median 9.62 cm2 [Q1: 7.07 cm2; Q3: 13.85 cm2]). Participants had more trust in AR than in NV (the differences posttest minus pretest were mean 0.9 [SD 1.2] and mean −0.3 [SD 0.2], respectively; p < 0.05).

The results of this study show a trend favoring the use of AR over NV with respect to reducing contact between a clip applier and the perifocal structures during a simulated clipping of an intracranial aneurysm. Target-guided craniotomies were smaller with the use of AR. AR may be used not only to localize surgical targets but also to prevent complications associated with damage to structures encountered during the surgical approach.

颅内微创手术意味着在被关键结构（例如血管和颅神经）包围的受限手术通道中工作。对它们的任何损坏都可能影响患者的预后。神经导航系统可以降低此类并发症的风险。在这项研究中，作者试图比较标准神经导航 (NV) 和增强现实 (AR) 引导导航在神经外科手术过程中使用模拟颅内血管的新型模型的焦周结构完整性。

一个定制的盒子，里面装有纵横交错的硬金属线，底部有一个隐藏的钉子，还有一个木制的顶部，为了研究的目的，被扫描、融合和参考。金属线和动脉瘤施夹器连接到一个控制器，该控制器计算它们之间的接触次数。23 名天真的参与者被要求 1) 使用 NV 在顶部定义最佳切入点，在木质顶部进行尽可能小的开颅手术，并在不接触金属线的情况下将夹子放在指甲上时使用手术显微镜; 2) 使用 AR 术前定义理想轨迹，导航手术显微镜，然后执行相同的任务。主要结果是金属线和施夹器之间的接触次数。次要结果是开颅手术的大小，

使用 AR 的接触人数中位数往往低于使用 NV（AR，中位数 1 [Q1：1，Q3：2]；NV，中位数 3 [Q1：1，Q3：6]；p = 0.074） . 与 NV 相比，使用 AR 的目标定向开颅术的大小显着降低（AR，中位数 4.91 cm2 [Q1：4.71 cm2，Q3：7.55 cm2]；和 NV，中位数 9.62 cm2 [Q1：7.07 cm2；Q3 : 13.85 平方厘米])。参与者对 AR 的信任度高于 NV（后测减去前测的差异分别为平均值 0.9 [SD 1.2] 和平均值 -0.3 [SD 0.2]；p < 0.05）。

这项研究的结果表明，在颅内动脉瘤的模拟夹闭过程中，在减少施夹器与焦周结构之间的接触方面，有利于使用 AR 而非 NV。使用 AR 时目标引导的开颅手术更小。AR 不仅可用于定位手术目标，还可用于预防与手术过程中遇到的结构损伤相关的并发症。