New Tools for Enhancing Cerebral Angiography: From Planning to Navigation

Project Summary Although neuronavigation systems are of crucial assistance during cerebrovascular surgery, they do not integrate hemodynamics information needed to treat complex cerebrovascular malformations. The present project aims at developing an Augmented Reality (AR) neuronavigation tool that will enable the visualization of cerebral hemodynamics information in the surgical view. Our long-term goal is to contribute toward the development and clinical adoption of visualization tools that allow for safe and accurate treatment of cerebrovascular malformations. Our overall objectives in this project are to (i) develop a novel approach based on deep neural networks that can classify and reconstruct 3D dynamic cerebral vasculature from 2D Digital Subtraction Angiography (DSA) image series, (ii) compose an AR visualization that will enhance the surgical view of the brain, and (iii) validate and evaluate our technology in real clinical settings. The rationale for this project is that such technology will provide a clear and interpretable visualization tool to surgeons that will support their decision-making process and reduce the time and complex spatial reasoning required to treat cerebrovascular malformations. To attain the overall objectives, the following three specific aims will be pursued: 1) develop and validate a method to classify artery and veins in DSA image series to visually disentangle AVMs, 2) develop and validate a method to build dynamic, virtual 3D model of cerebral vasculature from pairs of DSA image series and 3) build an AR visualization that aligns DSA image series with the surgical view and assess its impact providing surgical guidance. In addition, we will examine, through a clinical retrospective study, and through tests in the operating room on phantom data, the impact of this visualization in providing surgeons with guidance during cerebrovascular surgery. The proposed project is innovative because it will be possible to merge the true DSA-derived 3D cerebral hemodynamics with images of the brain surface seen through a surgical microscope. The proposed project is significant because it will provide visual guidance and confirmation to surgeons that will facilitate decision-making in the surgical treatment of complex AVMs. The results are expected to have an important positive impact because they will provide novel neuronavigation tools to improve the surgical treatment of cerebrovascular malformations and ultimately reduce the risks of intraoperative hemorrhaging and postsurgical deficits. Furthermore, the methods described here are cost-effective, adapted to low-resources settings, and can be easily implemented on a large scale, bringing advanced imaging techniques to far more patients.