Intraoperative Computed Tomography, Ultrasound, and Augmented Reality in Mesial Temporal Lobe Epilepsy Surgery—A Retrospective Cohort Study

Abstract

Mesial temporal lobe epilepsy (mTLE) surgery, particularly selective amygdalohippocampectomy (sAHE), is a recognized treatment for pharmacoresistant temporal lobe epilepsy (TLE). Accurate intraoperative orientation is crucial for complete resection while maintaining functional integrity. This study evaluated the usability and effectiveness of multimodal neuronavigation and microscope-based augmented reality (AR) with intraoperative computed tomography (iCT) and navigated intraoperative ultrasound (iUS) in 28 patients undergoing resective surgery. Automatic iCT-based registration provided high initial navigation accuracy. Navigated iUS was utilized to verify navigational accuracy and assess the extent of resection during the procedure. AR support was successfully implemented in all cases, enhancing surgical orientation, surgeon comfort, and patient safety, while also aiding training and education. At one-year follow-up, 60.7% of patients achieved complete seizure freedom (ILAE Class 1), rising to 67.9% at the latest follow-up (median 4.6 years). Surgical complications were present in three cases (10.7%), but none resulted in permanent deficits. The integration of microscope-based AR with iCT and navigated iUS provides a precise and safe approach to resection in TLE surgery, additionally serving as valuable tool for neurosurgical training and education.