OBJECTIVE: Endoscopes have been commonly used in transsphenoidal surgery to treat pituitary tumors, to compensate for the narrow surgical field. Although many navigation systems have been introduced for neurosurgical procedures, there have been few reports of navigation systems for endoscopic operations. This report presents our recently developed, endoscopic, augmented reality (AR) navigation system. METHODS: The technology is based on the principles of AR environment technology. The system consisted of a rigid endoscope with light-emitting diodes, an optical tracking system, and a controller. The operation of the optical tracking system was based on two sets of infrared lightemitting diodes, which measured the position and orientation of the endoscope relative to the patient's head. We used the system during endonasal transsphenoidal operations to treat pituitary tumors in 12 recent cases. RESULTS: Anatomic, "real," three-dimensional, virtual images of the tumor and nearby anatomic structures (including the internal carotid arteries, sphenoid sinuses, and optic nerves) were superimposed on real-time endoscopic live images. The system also indicated the positions and directions of the endoscope and the endoscopic beam in three- dimensional magnetic resonance imaging or computed tomographic planes. Furthermore, the colors of the wire-frame images of the tumor changed according to the distance between the tip of the endoscope and the tumor. These features were superior to those of conventional navigation systems, which are available only for operating microscopes. CONCLUSION: The endoscopic AR navigation system allows surgeons to perform accurate, safe, endoscope-assisted operations to treat pituitary tumors; it is particularly useful for reoperations, in which midline landmarks may be absent. We consider the AR navigation system to be a promising tool for safe, minimally invasive, endonasal, transsphenoidal surgery to treat pituitary tumors.
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