Augmented Reality Neuronavigation for En Bloc Resection of Spinal Column Lesions

BACKGROUND: Primary tumors involving the spine are relatively rare but represent surgically challenging pro-cedures with high patient morbidity. En bloc resection of these tumors necessitates large exposures, wide tumor margins, and poses risks to functionally relevant anatom-ical structures. Augmented reality neuronavigation (ARNV) represents a paradigm shift in neuronavigation, allowing on-demand visualization of 3D navigation data in real-time directly in line with the operative field.METHODS: Here, we describe the first application of ARNV to perform distal sacrococcygectomies for the en bloc removal of sacral and retrorectal lesions involving the coccyx in 2 patients, as well as a thoracic 9e11 lam-inectomy with costotransversectomy for en bloc removal of a schwannoma in a third patient.RESULTS: In our experience, ARNV allowed our teams to minimize the length of the incision, reduce the extent of bony resection, and enhanced visualization of critical adjacent anatomy. All tumors were resected en bloc, and the patients recovered well postoperatively, with no known complications. Pathologic analysis confirmed the en bloc removal of these lesions with negative margins.CONCLUSIONS: We conclude that ARNV is an effective strategy for the precise, en bloc removal of spinal lesions including both sacrococcygeal tumors involving the retro -rectal space and thoracic schwannomas.

Automated summary

This study demonstrates the effectiveness of ARNV in precise, en bloc removal of spinal lesions, including sacrococcygeal tumors and thoracic schwannomas.