Neurosurgical Planning Framework

Charting the course
in XR

Neurosurgery often targets very small parts of the brain using incredibly small tools. These surgeries, even though tiny in scale, require mountains of pre-operative planning and coordination to achieve the necessary precision — fractions of millimeters matter enormously.

We've built a neurosurgical planning framework in extended reality (XR)  that allows all the care providers involved — no matter their location — to come together and make a plan without sacrificing precision, saving time, expense, and most importantly, lives.

HoloDBS/SNS
Neurosurgical Planning in XR

"I could see it right away — XR was going to have a gigantically important niche application in this very specialized form of medicine."

CAMERON MCINTYRE, PHD
DUKE UNIVERSITY

Deep-Brain Stimulation (DBS), a type of stereotactic neurosurgery, has shown incredible results for patients suffering from Parkinson’s disease, depression, and other neurological conditions. In this procedure, individual axonal pathways (points of connection between different brain regions) are stimulated with electrodes to mitigate or even improve symptoms, such as tremors. However, even after centuries of study, there wasn’t a clear understanding of these structures in the brain — where they were, what they looked like, and what they did. Their significant clinical relevance drove the scientific community to learn more.

In 2019, Professor Cameron McIntyre (Duke University) collaborated with the Interactive Commons (IC) at Case Western Reserve University (CWRU) to build the first-ever 3D map of all the axonal pathways in a particular region of the brain — the subthalamic nucleus, previously identified as a critically important target for DBS. To do so, he invited the world's leading basal ganglia neuroanatomists to Cleveland to put their heads together and build the map. The project, funded through a $2.3M NIH grant (R01 NS105690), resulted in not only new insights about brain structure (published in Neuron), but also gave McIntyre an idea —

What if we could make not just a general atlas for research, but a patient-specific map to plan a surgery?

Photo: Cleveland FES Center

"I'd seen it a thousand times on a regular 2D screen, but it was really different to see it in the scale and scope and in true 3D. I will always remember that moment — it changed my perception of how these pathways in the brain actually line up with each other."

CAMERON MCINTYRE, PHD
DUKE UNIVERSITY

In the following years, McIntyre and his lab have continued to develop this idea with the IC. The tool now allows users to examine a holographic representation of a patient’s brain scans, identify the relevant regions for therapy, and decide on exact coordinates and angles for the insertion of the electrodes. These positions are then saved and applied in the actual procedure. Not only has this method been successfully used in multiple operations to date, but there was an unforeseen gain, as well — it was an easier way to have a meeting.

The team responsible for coordinating, planning, and executing a neurosurgical operation is usually made up of very busy people. Whether they are working out of different hospitals or their demanding schedules keep them booked out, it can be challenging to get all the care providers together to look at the same data at the same time. Using this application, remotely-connected care providers were able to synchronously work together from different physical locations, even though they were based hundreds of miles away from one another.

To see what surgical planning in XR looks like, check out the video below from our visit with NBC Nightly News:

Join us.

To learn more about how to get involved and support development, send us a message: ic@case.edu