{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T17:57:00Z","timestamp":1778263020807,"version":"3.51.4"},"reference-count":30,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T00:00:00Z","timestamp":1651795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: The aim of surgery for skull base meningiomas is maximal resection with minimal damage to the involved cranial nerves and cerebral vessels; thus, implementation of technologies for improved orientation in the surgical field, such as neuronavigation and augmented reality (AR), is of interest. Methods: Included in the study were 39 consecutive patients (13 male, 26 female, mean age 64.08 \u00b1 13.5 years) who underwent surgery for skull base meningiomas using microscope-based AR and automatic patient registration using intraoperative computed tomography (iCT). Results: Most common were olfactory meningiomas (6), cavernous sinus (6) and clinoidal (6) meningiomas, meningiomas of the medial (5) and lateral (5) sphenoid wing and meningiomas of the sphenoidal plane (5), followed by suprasellar (4), falcine (1) and middle fossa (1) meningiomas. There were 26 patients (66.6%) who underwent gross total resection (GTR) of the meningioma. Automatic registration applying iCT resulted in high accuracy (target registration error, 0.82 \u00b1 0.37 mm). The effective radiation dose of the registration iCT scans was 0.58 \u00b1 1.05 mSv. AR facilitated orientation in the resection of skull base meningiomas with encasement of cerebral vessels and compression of the optic chiasm, as well as in reoperations, increasing surgeon comfort. No injuries to critical neurovascular structures occurred. Out of 35 patients who lived to follow-up, 33 could ambulate at their last presentation. Conclusion: A microscope-based AR facilitates surgical orientation for resection of skull base meningiomas. Registration accuracy is very high using automatic registration with intraoperative imaging.<\/jats:p>","DOI":"10.3390\/cancers14092302","type":"journal-article","created":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T02:46:39Z","timestamp":1651805199000},"page":"2302","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Microscope-Based Augmented Reality with Intraoperative Computed Tomography-Based Navigation for Resection of Skull Base Meningiomas in Consecutive Series of 39 Patients"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6123-5589","authenticated-orcid":false,"given":"Mirza","family":"Pojski\u0107","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Marburg, 35037 Marburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1574-7572","authenticated-orcid":false,"given":"Miriam H. A.","family":"Bopp","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Marburg, 35037 Marburg, Germany"},{"name":"Marburg Center for Mind, Brain and Behavior (CMBB), 35032 Marburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2855-3443","authenticated-orcid":false,"given":"Benjamin","family":"Sa\u03b2","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Marburg, 35037 Marburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Carl","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Marburg, 35037 Marburg, Germany"},{"name":"Department of Neurosurgery, Helios Dr. Horst Schmidt Kliniken, 65199 Wiesbaden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8216-9410","authenticated-orcid":false,"given":"Christopher","family":"Nimsky","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Marburg, 35037 Marburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"172","DOI":"10.4103\/2152-7806.170023","article-title":"Multimodal navigated skull base tumor resection using image-based vascular and cranial nerve segmentation: A prospective pilot study","volume":"6","author":"Dolati","year":"2015","journal-title":"Surg. Neurol. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1159\/000094462","article-title":"Application Accuracy of Automatic Registration in Frameless Stereotaxy","volume":"84","author":"Rachinger","year":"2006","journal-title":"Stereotact. Funct. Neurosurg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1016\/j.joms.2007.12.019","article-title":"Fully Automated Registration of Intraoperative Computed Tomography Image Data for Image-Guided Craniofacial Surgery","volume":"66","author":"Eggers","year":"2008","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1007\/s00701-018-3641-6","article-title":"Intraoperative computed tomography as reliable navigation registration device in 200 cranial procedures","volume":"160","author":"Carl","year":"2018","journal-title":"Acta Neurochir."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2181","DOI":"10.1007\/s00701-019-04005-0","article-title":"Augmented reality in intradural spinal tumor surgery","volume":"161","author":"Carl","year":"2019","journal-title":"Acta Neurochir."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.neuchi.2014.07.001","article-title":"Augmented reality-assisted skull base surgery","volume":"60","author":"Cabrilo","year":"2014","journal-title":"Neurochirurgie"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e873","DOI":"10.1016\/j.wneu.2019.01.202","article-title":"Augmented Reality in Transsphenoidal Surgery","volume":"125","author":"Carl","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Lai, M., Skyrman, S., Shan, C., Babic, D., Homan, R., Edstr\u00f6m, E., Persson, O., Burstr\u00f6m, G., Elmi-Terander, A., and Hendriks, B.H. (2020). Fusion of augmented reality imaging with the endoscopic view for endonasal skull base surgery; a novel application for surgical navigation based on intraoperative cone beam computed tomography and optical tracking. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0229454"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1007\/s00381-021-05049-3","article-title":"First experience with augmented reality neuronavigation in endoscopic assisted midline skull base pathologies in children","volume":"37","author":"Pennacchietti","year":"2021","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1097\/MAO.0000000000002724","article-title":"Early Feasibility Studies of Augmented Reality Navigation for Lateral Skull Base Surgery","volume":"41","author":"Creighton","year":"2020","journal-title":"Otol. Neurotol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00701-021-05045-1","article-title":"Augmented reality visualization in brain lesions: A prospective randomized controlled evaluation of its potential and current limitations in navigated microneurosurgery","volume":"164","author":"Roethe","year":"2021","journal-title":"Acta Neurochir."},{"key":"ref_12","first-page":"369","article-title":"Augmented reality in intracranial meningioma surgery: Report of a case and systematic review","volume":"64","author":"Meling","year":"2020","journal-title":"J. Neurosurg. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"E610","DOI":"10.1093\/ons\/opaa238","article-title":"Mini-Pterional Craniotomy and Extradural Clinoidectomy for Clinoid Meningioma: Optimization of Exposure Using Augmented Reality Template: 2-Dimensional Operative Video","volume":"19","author":"Jean","year":"2020","journal-title":"Oper. Neurosurg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.3171\/2018.1.FOCUS1843","article-title":"Introduction. Skull base meningioma treatment strategies","volume":"44","author":"McDermott","year":"2018","journal-title":"Neurosurg. Focus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.3171\/2018.6.JNS18118","article-title":"Surgical outcomes after reoperation for recurrent non\u2013skull base meningiomas","volume":"131","author":"Magill","year":"2018","journal-title":"J. Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s10143-018-0976-7","article-title":"Meningiomas: Skull base versus non-skull base","volume":"42","author":"Meling","year":"2018","journal-title":"Neurosurg. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"DeMonte, F., McDermott, M.W., and Al-Mefty, O. (2011). Al-Mefty\u2019s Meningiomas, Thieme Medical Publishers Inc.","DOI":"10.1055\/b-002-80424"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1136\/jnnp.20.1.22","article-title":"The Recurrence of intracranial meningiomas after surgical treatment","volume":"20","author":"Simpson","year":"1957","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1186\/1471-2407-10-615","article-title":"Treatment of patients with atypical meningiomas Simpson grade 4 and 5 with a carbon ion boost in combination with postoperative photon radiotherapy: The MARCIE Trial","volume":"10","author":"Combs","year":"2010","journal-title":"BMC Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e74","DOI":"10.1016\/j.wneu.2017.12.035","article-title":"Differential Tumor Progression Patterns in Skull Base Versus Non\u2013Skull Base Meningiomas: A Critical Analysis from a Long-Term Follow-Up Study and Review of Literature","volume":"112","author":"Savardekar","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.wneu.2011.09.004","article-title":"Evolution and future of skull base surgery: The paradigm of skull base meningiomas","volume":"78","author":"Ramanathan","year":"2012","journal-title":"World Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.wneu.2020.04.043","article-title":"Enhancing Reality: A Systematic Review of Augmented Reality in Neuronavigation and Education","volume":"139","author":"Cho","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.nec.2017.05.010","article-title":"Intraoperative Computed Tomography in Cranial Neurosurgery","volume":"28","author":"Schichor","year":"2017","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.3171\/2015.5.JNS15330","article-title":"Orbit-associated tumors: Navigation and control of resection using intraoperative computed tomography","volume":"124","author":"Terpolilli","year":"2016","journal-title":"J. Neurosurg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1007\/s00106-016-0215-x","article-title":"Intraoperative navigation, with focus on the skull base","volume":"64","author":"Wirtz","year":"2016","journal-title":"HNO"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1007\/s00701-013-1662-8","article-title":"Image-guided resection of spheno-orbital skull-base meningiomas with predominant intraosseous component","volume":"155","author":"Marcus","year":"2013","journal-title":"Acta Neurochir."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"E11","DOI":"10.3171\/2019.8.FOCUS19621","article-title":"Reliable navigation registration in cranial and spine surgery based on intraoperative computed tomography","volume":"47","author":"Carl","year":"2019","journal-title":"Neurosurg. Focus"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e134","DOI":"10.1016\/j.wneu.2019.05.062","article-title":"Visualization of Dark Side of Skull Base with Surgical Navigation and Endoscopic Assistance: Extended Petrous Rhomboid and Rhomboid with Maxillary Nerve\u2013Mandibular Nerve Vidian Corridor","volume":"129","author":"Watanabe","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/j.wneu.2015.12.101","article-title":"Utility of Neuronavigation in Intracranial Meningioma Resection: A Single-Center Retrospective Study","volume":"90","author":"Bir","year":"2016","journal-title":"World Neurosurg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e32","DOI":"10.1016\/j.wneu.2017.09.184","article-title":"Surgical Management of Giant Intracranial Meningioma: Operative Nuances, Challenges, and Outcome","volume":"110","author":"Narayan","year":"2018","journal-title":"World Neurosurg."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/9\/2302\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:06:44Z","timestamp":1760137604000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/9\/2302"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,6]]},"references-count":30,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["cancers14092302"],"URL":"https:\/\/doi.org\/10.3390\/cancers14092302","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,6]]}}}