Mixed Reality-Assisted Surgical Planning of Flow-Augmentation Extracranial-Intracranial Bypass Surgery: A Technical Note

OBJECTIVE: Precise choice of adequate donor and recipient arteries for an extracranial-intracranial (EC-IC) bypass remains a challenge. Herein, authors present the use of a novel three-dimensional mixed reality (MxR) system for preoperative planning of flow-augmentation EC-IC bypass. METHODS: All elective flow-augmentation EC-IC bypass cases from June 2022 to March 2023 were prepared with MxR and matched with a retrospective cohort of bypass procedures prepared without MxR. Perioperative patient data, holographic preparation time, intraoperative bypass flow, and postoperative patency were documented. The time required to delineate the superficial temporal artery manually, with Doppler or with the hologram, was collected. RESULTS: Ten flow-augmentation EC-IC bypass cases planned with MxR were included in the analysis. Mean holographic preparation time was 36 +/- 12 minutes. No statistically significant differences were observed in intraoperative bypass flow, or mean craniotomy diameter between the two groups. Meantime to delineate the superficial temporal artery with MxR was significantly lower than that required manually (mean difference 5 minutes; 95% confidence interval: 0.3-10.3) and with Doppler (mean difference 4 minutes; 95% confidence interval: 2.1-6.7). CONCLUSIONS: Surgical planning of flow-augmentation EC-IC bypass procedures with three-dimensional interactive holograms is feasible and relatively fast. Future studies should focus more extensively on a potentially associated improvement in surgical outcomes.