BACKGROUND AND OBJECTIVES: External ventricular drain (EVD) placement is often performed freehand, a technique subpar to accurate yet impractical image-guided methods, yielding optimal placement in only 70%. The aim of this study was to address shortcomings in EVD placement and image guidance technologies by implementing high-accuracy augmented reality (AR) guidance.METHODS: We conducted a prospective clinical pilot study to assess feasibility, safety, and clinical performance of EVD placement using a standalone AR headset equipped with high-accuracy inside-out infrared tracking and software addressing EVD placement. Placement quality was reported using a newly defined extended modified Kakarla scale, and dichotomized into clinically relevant outcome parameters. Results were compared with a nonconcurrent freehand control group using one-sided Fisher exact tests.RESULTS: Eleven AR-guided EVD placements were performed, achieving functional placement in all cases on the first attempt, vs 7 (64%) in the control group (P = .045); successful placement in 9 (82%) vs 5 (45%); optimal in 8 (73%) vs 3 (27%) (P = .043); suboptimal in 2 (18%) vs 5 (45%); and failed in 0 vs 1 (9%). No AR-guided placements required revision, whereas the freehand group had a 36% reintervention rate (P = .045). Procedure-related complications occurred in 2 AR-guided cases (18%), vs 5 (45%) freehand (all post-reintervention).CONCLUSION: This study presents the first clinical use case of EVD placement using high-accuracy AR guidance contained in a standalone head-worn navigation system. Safe and reliable outcomes using a validated pipeline were demonstrated, eliminating stick-and-poke attempts and resulting in improved quality, increased single attempt success rates, and reduced revision and complication rates. Based on these results, a multicenter randomized controlled trial will be initiated.
Van Gestel, F, Frantz, T, Buyck, F, Gallagher, AG, Geens, W, Neuville, Q, Bruneau, M, Jansen, B, Scheerlinck, T, Vandemeulebroucke, J & Duerinck, J 2025, 'High-Accuracy Augmented Reality Guidance for Intracranial Drain Placement Using a Standalone Head-Worn Navigation System: First-in-Human Results', Neurosurgery, vol. 96, no. 6, 10.1227/neu.0000000000003401, pp. 1217-1226. https://doi.org/10.1227/neu.0000000000003401
Van Gestel, F., Frantz, T., Buyck, F., Gallagher, A. G., Geens, W., Neuville, Q., Bruneau, M., Jansen, B., Scheerlinck, T., Vandemeulebroucke, J., & Duerinck, J. (2025). High-Accuracy Augmented Reality Guidance for Intracranial Drain Placement Using a Standalone Head-Worn Navigation System: First-in-Human Results. Neurosurgery, 96(6), 1217-1226. Article 10.1227/neu.0000000000003401. https://doi.org/10.1227/neu.0000000000003401
@article{5d789d7f66564eadb38bc56236b9d503,
title = "High-Accuracy Augmented Reality Guidance for Intracranial Drain Placement Using a Standalone Head-Worn Navigation System: First-in-Human Results",
abstract = "BACKGROUND AND OBJECTIVES: External ventricular drain (EVD) placement is often performed freehand, a technique subpar to accurate yet impractical image-guided methods, yielding optimal placement in only 70%. The aim of this study was to address shortcomings in EVD placement and image guidance technologies by implementing high-accuracy augmented reality (AR) guidance.METHODS: We conducted a prospective clinical pilot study to assess feasibility, safety, and clinical performance of EVD placement using a standalone AR headset equipped with high-accuracy inside-out infrared tracking and software addressing EVD placement. Placement quality was reported using a newly defined extended modified Kakarla scale, and dichotomized into clinically relevant outcome parameters. Results were compared with a nonconcurrent freehand control group using one-sided Fisher exact tests.RESULTS: Eleven AR-guided EVD placements were performed, achieving functional placement in all cases on the first attempt, vs 7 (64%) in the control group (P = .045); successful placement in 9 (82%) vs 5 (45%); optimal in 8 (73%) vs 3 (27%) (P = .043); suboptimal in 2 (18%) vs 5 (45%); and failed in 0 vs 1 (9%). No AR-guided placements required revision, whereas the freehand group had a 36% reintervention rate (P = .045). Procedure-related complications occurred in 2 AR-guided cases (18%), vs 5 (45%) freehand (all post-reintervention).CONCLUSION: This study presents the first clinical use case of EVD placement using high-accuracy AR guidance contained in a standalone head-worn navigation system. Safe and reliable outcomes using a validated pipeline were demonstrated, eliminating stick-and-poke attempts and resulting in improved quality, increased single attempt success rates, and reduced revision and complication rates. Based on these results, a multicenter randomized controlled trial will be initiated.",
author = "{Van Gestel}, Frederick and Taylor Frantz and F{\'e}lix Buyck and Gallagher, {Anthony G} and Wietse Geens and Quentin Neuville and Michael Bruneau and Bart Jansen and Thierry Scheerlinck and Jef Vandemeulebroucke and Johnny Duerinck",
note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons. T.",
year = "2025",
month = jun,
doi = "10.1227/neu.0000000000003401",
language = "English",
volume = "96",
pages = "1217--1226",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "6",
}