First use of computer-generated holography in neuroendovascular simulation and intraoperative assistance: A preliminary study

Background Computer-generated holograms (CGHs) are advanced, glassless, three-dimensional (3D) representations. This study reports the first surgical application of CGH for preoperative and intraoperative assistance. Methods In this single-center case series and observational survey study, three consecutive patients with intracranial aneurysms were scheduled for endovascular treatment; in one case, observation was selected instead of treatment. Twelve neurosurgical residents were recruited to inspect the CGHs and complete a questionnaire. CGHs were inspected pre- and intraoperatively in two patients with flow-diverter stents. For validation, neurosurgical residents inspected conventional 3D rotational angiograms, then CGHs, and completed a questionnaire. We compared correct answer rates on a questionnaire assessing 3D anatomical understanding at 10 locations using CGHs versus conventional methods. Simulator Sickness Questionnaire (SSQ) scores were used to assess safety. Outcomes were defined a priori. Results Correct answer rates were higher with CGH than with two-dimensional working angle images (median, 75% vs. 60%; p < .01). Mean SSQ scores were nausea,0.80; oculomotor, 13.9; disorientation, 12.8; and total severity, 10.6. Intraoperative CGH reference particularly assisted the operating surgeon in visualizing and simulating the course of the guidewire across the neck in flow-diverter placement of a giant internal carotid artery aneurysm. Conclusions The 3D visualization of anatomical structures in CGH was quantitatively validated in the present study. Comprehension of CGH did not require particular training or prior experience, and its safety profile was also evaluated. CGH may serve as an effective tool for surgical assistance and education, particularly in anatomically complex cases.