Access to potentially life-saving neurosurgical care remains uneven worldwide—with potentially fatal consequences. This is especially true for the most common neurosurgical procedure: ventriculostomy. Ventriculostomy involves inserting a catheter into the brain’s cavities (called ventricles) to drain cerebrospinal fluid and relieve intracranial pressure.

It’s a delicate, difficult process that requires extreme precision: misplacing the catheter, which happens in up to 30% of freehand procedures, can result in hemorrhage, infection, prolonged hospital stays, morbidity and even death.

That’s why a group of Gina Cody School of Engineering and Computer Science researchers sought to develop a low-cost technology that could improve the accuracy of the procedure. Marta Kersten-Oertel, an associate professor in the Department of Computer Science and Software Engineering, and her team have developed an augmented-reality (AR)-based platform. They say it may make ventriculostomies far safer and more accurate, especially in low- and middle-income countries and settings with limited resources.

Known as the iSurgARy system, the platform uses LiDAR, a light detection and ranging technology, to help surgeons identify specific landmarks on a patient’s skull and accurately map them to the patient’s preoperative CT or MRI images. AR is then used to project the ventricles onto the patient. The creators describe the technology in the Healthcare Technology Letters journal.

“The technology offers better spatial awareness of patient anatomy, which provides surgeons with better aim at their target points,” says co-author Joshua Pardillo Castillo, MSc 24. “The augmented reality overlays the patient’s medical images so the surgeon can better see how to best position the catheter.”

LiDAR, built into the rear cameras of various Apple iOS devices, helps determine the distances from the sensor to seven anatomical landmarks on a patient’s head: the tragus (the pointed eminence jutting out from the scalp at the front of the ear) on both sides of the head, the outer eyes, the inner eyes, and the bridge of the nose. These landmarks are used to align the virtual models of the patient’s anatomy to the actual patient, providing medical personnel with an augmented reality view that indicates where the ventricles are.

This visualization guides the clinician to the optimal location for placing the catheter, while the catheter’s tracking tool can provide spatial understanding of the distance between the tip of the catheter and the ventricles.

“The AR view shows where the ventricles are so clinicians can decide on the best approach,” Kersten-Oertel explains. “The freehand technique relies on bony landmarks of the skull, and clinicians make their decisions based on them. But if there is a brain tumour or traumatic injury causing pressure, the brain may have shifted so the ventricles are not where they are expected to be. This system allows users to see the ventricles projected on the patient and target them accurately.”

The platform emerged out of a practical need identified by an experienced clinician: David Sinclair, a clinical professor in cerebrovascular and skull base neurosurgery with the Division of Neurosurgery of McGill University’s Department of Neurology and Neurosurgery. Sinclair, who is also a co-author on the paper, asked Kersten-Oertel if it was possible to develop a tool that would improve visualization to target ventricles in scenarios where time, cost and accuracy are of utmost importance.

“This kind of collaboration with a neurosurgeon in the design and discovery phase makes this project unique,” says Zahra Asadi, a PhD student and co-first author on the paper. “Working with him and getting to know the needs of the people who will use this application is critical.”

This article was adapted and published with permission from Concordia University.