Clinical Report: AR vs Freehand Techniques for EVD Insertion in Phantom Models

Overview

This multicenter randomized controlled crossover study compared augmented reality (AR) assisted external ventricular drain (EVD) placement to the conventional freehand technique using anatomically realistic phantom models. The AR system demonstrated improved accuracy and user experience without increasing procedural time, suggesting potential clinical benefits for neurosurgical practice.

Background

External ventricular drain placement is a critical neurosurgical procedure commonly performed for obstructive hydrocephalus and traumatic brain injury. The traditional freehand technique relies on anatomical landmarks but is associated with a high rate of catheter misplacement, leading to increased risks of hemorrhage, infection, and revision surgeries. Neuronavigation systems improve accuracy but are costly and complex, limiting their use in emergencies. Augmented reality head-mounted displays offer stereoscopic 3-D visualization directly over the patient, potentially enhancing accuracy and workflow efficiency in EVD placement.

Data Highlights

Six biomimetic 3-D printed head phantoms were fabricated from CT scans of patients with subarachnoid hemorrhage, representing moderate to very difficult procedural challenges.

Key Findings

• AR-assisted EVD placement improved catheter insertion accuracy compared to the freehand technique in simulated challenging cases.
• The AR system "Lumi" operates locally on AR-HMDs without external sensors, enabling flexible image-to-patient registration and continuous tracking.
• Procedural times were comparable between AR-assisted and freehand techniques, indicating no added time burden with AR use.
• User experience questionnaires showed enhanced surgeon confidence and visualization with AR assistance.
• The system integrates with hospital PACS infrastructure and automated segmentation, supporting clinical workflow compatibility.

Clinical Implications

Augmented reality-assisted EVD placement may reduce catheter misplacement rates and associated complications without increasing procedure duration. The portability and integration capabilities of the AR system make it suitable for emergency and resource-limited settings, potentially improving patient outcomes in neurosurgical care.

Conclusion

This study demonstrates that AR-HMD technology can enhance the accuracy and user experience of EVD placement in simulated environments, supporting its potential for clinical adoption. Further clinical trials are warranted to confirm these benefits in real-world settings.

References

1. UMC Utrecht et al. 2024 -- Evaluating AR vs Freehand Techniques for EVD Insertion