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Feasibility and workflow analysis of IV-DSA-based augmented reality-guided brain arteriovenous malformation resection in a hybrid operating room: i-Flow tailored method
  1. Chih-Wei Huang1,
  2. Chung-Hsin Lee1,
  3. Kai-Chen Chung1,
  4. Yuang-Seng Tsuei1,2
  1. 1Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan
  2. 2Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
  1. Correspondence to Dr Yuang-Seng Tsuei, Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan; astrocytoma2001{at}


Augmented reality (AR) has emerged as a promising technology in various medical fields.1 2 In the context of brain arteriovenous malformation (bAVM) surgery, AR offers the potential to enhance surgical visualization and improve procedural accuracy.3 ,4 ,5 6 This report aims to explore the application of digital subtraction angiography (DSA) from an IV contrast injection (IV-DSA) in AR-guided resection of bAVMs in a neurosurgical hybrid operating room.

The workflow of IV-DSA-based AR-guided surgery for the resection of bAVMs consists of four main components: (1) acquiring source images through i-Flow tailored or multiphase scans (Siemens, Germany); (2) labelling targets in the workstation using Smartbrush software (Brainlab, Westchester, Illinois, USA); (3) using the Brainlab Curve navigation system; and (4) merging microscopic AR fusion using Zeiss Kinevo (AG, Germany). In video 1 we show the entire workflow and introduce i-Flow tailored IV-DSA data acquisition in the hybrid operating room. In summary, IV-DSA-based augmented reality is an innovative technique for bAVM surgery.

Video 1 -i-flow tailored iv-DSA

  • Angiography
  • Arteriovenous Malformation
  • Technique

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  • Contributors Data acquisition: CH-L, KC-C. Drafting: CW-H. Design and final approval: YS-T.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.