Last week Mount Sinai Health System announced the first use of new imaging technology that combines virtual reality with the eyepiece of a microscope for neurosurgery. The CaptiView image system consolidated with Brainlab Cranial 3.1 Navigation Software and a Leica M530 OH6 microscope allows the surgeon to view live and pre-operative anatomical images simultaneously or in any combination he selects by toggling controls with hand or feet.

Dr. Joshua Bederson, an expert in skull-base and cerebrovascular surgery who has performed more than 3,600 neurosurgical operations at Mount Sinai, was involved with the development of this technology and the first surgeon to deploy it in the operating room. HCB News spoke with Dr. Bederson about the impact of this advance in surgical navigation technology.

HCB News: These developments have been described as GPS or Pokeman Go for brain surgery. Do you consider these to be apt comparisons?
Joshua Bederson: What we first do is create a virtual world. Think of the movie Avatar. If you combine a CT scan, a histogram, and include difference sequences of an MRI scan, you will create a virtual rendition of the patient in which you can vary the transparency of the brain structures.

Then we link that virtual map to the patient’s actual anatomy. So we have an Avatar-like 3D environment that is linked in real time to the anatomy of the patient, sort of like a GPS read-out superimposed onto the “geography” of the brain. This combination is analogous to a GPS system.

Then, we “inject” all of these elements into a heads up display that is superimposed over what we are actually looking at through the microscope. You can think of this as similar to the heads up display a fighter pilot looks at in the glass of his windshield as he is trying to land a fighter jet onto an aircraft carrier. All he really sees is a dot in the distance, but given the heads up display he can see the approach pathways through the clouds, etc.

So, the GPS is tied together with an Avatar-like virtual reality environment and all that is projected, on command, into the eyepiece, layered over the surgeon’s vision of the patient’s anatomy.

HCB News: Does the “heads up display” make that much of a difference to the surgeon and the outcome of the procedure?

JB: It does! Getting back to the pilot analogy. As a pilot you learn very early on that the first thing you have to do is “fly the plane.” All of the instrumentation brings critical information into the pilot’s awareness, but you have to shift your attention away from ‘“flying the plane” to get that information.

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