This study will evaluate the application of a metaverse-based surgical simulation platform in extracranial-intracranial (EC-IC) bypass surgery. The study population will include patients with moyamoya disease or chronic cerebral ischemia who are scheduled to undergo EC-IC bypass surgery. Before surgery, preoperative brain computed tomography images will be imported into the metaverse surgical simulation platform. During surgery, extended reality technology will be used to provide precise localization of the relevant vessels, including both the donor and recipient arteries. The primary objective is to assess the localization accuracy of this platform. The study will also investigate whether this technology can facilitate a minimally invasive surgical approach and improve surgical safety.
Study Type
OBSERVATIONAL
Enrollment
30
NTU OpVerse is a patient-specific metaverse-based surgical simulation and assistance platform developed through collaboration among National Taiwan University Hospital, National Taiwan University, and technology partners. The platform integrates medical-image processing, three-dimensional reconstruction, digital-twin technology, and extended reality, including virtual, augmented, and mixed-reality applications. Patient-specific computed tomography or magnetic resonance imaging data can be imported into the platform and reconstructed into interactive three-dimensional anatomical models. These models allow surgeons to visualize the spatial relationships among target lesions, blood vessels, organs, bones, and other relevant anatomical structures. Through an immersive extended-reality interface, surgeons can manipulate the reconstructed models, examine them from different perspectives, and conduct individualized preoperative planning and procedural simulation.
National Taiwan University Hospital
Taipei, Taiwan
RECRUITINGAccuracy of XR-Assisted Superficial Temporal Artery Localization
Accuracy will be assessed as the absolute distance, measured in millimeters, between the superficial temporal artery location marked using the XR-assisted surgical planning system and the actual superficial temporal artery location identified by vascular ultrasonography. The mean absolute distance error across participants will be reported.
Time frame: During preoperative surgical planning and intraoperative confirmation on the day of surgery.
Accuracy of XR-Assisted Middle Cerebral Artery Recipient-Vessel Prediction
Accuracy will be assessed as the absolute distance, measured in millimeters, between the anastomosis site predicted using the XR-assisted surgical planning system and the actual recipient-vessel anastomosis site selected intraoperatively. The mean absolute distance error across participants will be reported.
Time frame: From preoperative surgical planning to intraoperative selection of the recipient vessel on the day of surgery.
XR-Assisted STA Localization Time
The time required to localize and mark the superficial temporal artery and middle cerebral artery using the XR-assisted system will be measured in minutes, from initiation of XR registration and localization to completion of skin marking.
Time frame: During preoperative preparation on the day of surgery.
Time From Skin Incision to Identification of the Recipient Vessel
The time from the initial skin incision to intraoperative identification of the middle cerebral artery recipient vessel selected for bypass will be measured in minutes.
Time frame: During the surgical procedure on the day of surgery.
Total Operative Time
Total operative time will be measured in minutes, from the initial skin incision to completion of skin closure.
Time frame: During the surgical procedure on the day of surgery.
Skin-Incision Length
The length of the final skin incision will be measured in centimeters after completion of the surgical procedure.
Time frame: At completion of skin closure on the day of surgery.
Maximum Craniotomy Diameter
The maximum diameter of the completed craniotomy will be measured in centimeters intraoperatively.
Time frame: During the surgical procedure on the day of surgery.
Intraoperative Enlargement of the Planned Craniotomy
The number and percentage of participants requiring intraoperative enlargement of the craniotomy beyond the preoperatively planned dimensions will be reported.
Time frame: During the surgical procedure on the day of surgery.
Intraoperative Bypass Blood Flow
Blood flow through the completed bypass will be measured in milliliters per minute using an intraoperative flow-measurement device after completion of the anastomosis.
Time frame: Immediately after completion of the bypass anastomosis on the day of surgery.
Postoperative Ischemic Complications
The number and percentage of participants experiencing a new postoperative cerebral ischemic event, including transient ischemic attack or ischemic stroke, will be reported. Events will be determined by neurological assessment and clinically indicated neuroimaging.
Time frame: From completion of surgery through 30 days after surgery.
Postoperative Hemorrhagic Complications
The number and percentage of participants experiencing a new postoperative intracranial hemorrhagic complication will be reported. Events will be determined by neurological assessment and postoperative neuroimaging
Time frame: From completion of surgery through 30 days after surgery.
Change in Modified Rankin Scale Score
The change in modified Rankin Scale score will be calculated as the postoperative score minus the preoperative baseline score. The modified Rankin Scale ranges from 0 to 6, with higher scores indicating greater disability.
Time frame: From baseline before surgery to 30 days after surgery.
Length of Intensive Care Unit Stay
The duration of postoperative intensive care unit stay will be measured in days, from admission to the intensive care unit after surgery to transfer out of the intensive care unit.
Time frame: From completion of surgery through discharge from the intensive care unit, up to 30 days after surgery.
Total Length of Hospital Stay
The total postoperative hospital stay will be measured in days, from the date of surgery to the date of hospital discharge.
Time frame: From the date of surgery through hospital discharge, up to 30 days after surgery.
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