[FG] Soleman Jehuda

ENDOVEST (Endoscopic Third Ventriculostomy compared to Ventriculoperitoneal Shunt as Treatment for Idiopathic Normal Pressure Hydrocephalus) is a national multi-center, two-arm, open labelled randomized controlled trial comparing endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) for the treatment of idiopathic normal pressure hydrocephalus (iNPH). The aim of this study is to assess weither ETV is superior to VPS in terms of complication rate and wether ETV is non-inferior to VPS regarding postoperative clinical improvement for treating iNPH.

EMINENT-ICH (Early minimally invasive image guided endoscopic evacuation of intracerebral hemorrhage) is a national multi-center, two-arm, open labelled randomized controlled trial comparing minimal invasive endoscopic evacuation and best medical treatment (blood pressure monitoring and intensive care) of spontaneous intracranial bleeding (hemorrhagic stroke). Treatment options for spontaneous intracranial bleedings are very limited and result in over half of the patients in very poor neurological outcome or death. The aim of this study is to assess in a randomized fashion whether an early (within 24 hours), complete, minimal invasive endoscopic hematoma evacuation will improve functional outcome and lower mortality rates as opposed to the current practice of best medical treatment.

ProCoN-Study (Prospective neuroCognitive assessment in Neuroendoscopy) is a prospective cohort study investigating the influence of neuroendoscopic surgery for various indications (e.g. hydrocephalus, intraventricular and intracerebral cysts, intraventricular tumors) on neurocognitive functions and outcome in approximately 100 adult patients over a 5-year period. Intracranial neuroendoscopy has significantly reduced complications linked to traditional craniotomies, yet often necessitates navigation around neural structures vital for neurocognitive functions. Unfortunately, the impact on neurocognition is frequently overlooked and possibly underestimated, emphasizing the need for a comprehensive analysis. We aim to identify postoperative neurocognitive deficits and recovery rates through a battery of 19 neurocognitive tests. Neuropsychologists from the Memory Clinic at the Felix Platter Spital will conduct comprehensive assessments both before surgery and at multiple postoperative intervals, enabling a meticulous exploration of neuroendoscopic surgery's cognitive impact. In addition, postoperative radiological results will be assessed, while patient reported outcome measurements (PROMs), looking at the patients subjective opinion on their outcome and neurocognitive function, is evaluated as well.

Background:

The project results from an established collaboration of the VR/AR Platform of the Department of Surgery, USB and the Department of Biomedical Engineering (DBE) of the University of Basel. The Principal Investigator, Dr. Maria Licci, is the initiator of the ViaREal Spine Project and the clinical Co-Supervisor of both the PhD Students of the DBE working on the continuing VR Specto software development. The clinical studies are conducted in a single center setting at the Department of Orthopedics and the Division of Neurosurgery, University Children’s Hospital Basel. The projects involve clinical and radiographic data analysis and surgical PROMS collection, for patient-specific VR-based spinal and craniovertebral junction deformity visualization and for mixed VR/AR correction planning and surgery. The implementation of the existing VR/AR-Specto Software is performed at the Department of Biomedical Engineering of the University Basel. 

Research question:

In detail, the project of development of a mixed VR/AR Reality based simulation platform seeks to:

1.    Validate the VR-based cranio-spinal simulation’s measurement accuracy and reliability against traditional imaging techniques

-      Comparison of biplanar X-rays, 2D EOS, 3D EOS reconstruction, CT Datasets, innovative MRI black bone sequence datasets

2.    Enhance 3D anatomical understanding and profile simulation for accurate deformity correction

-      Including surgical training studies on 3D cranio-spinal deformity specimens

3. Decrease reliance on high radiation imaging techniques, ensuring radioprotection for pediatric patients.

-      Replace high-radiation CT imaging with non-ionizing black-bone MRI sequences

-      financing for additional radiological reconstruction sequences is granted by a separate Grant received by the Applicant (Bangerter-Rhyner Stiftung, 80’000 CHF)

4.   Integrate VR and AR for enhanced surgical planning, intraoperative navigation, patient education and medical training

-      Including improved patient informed consent making clinical studies, PROMS data collection and analysis of clinical data for surgical outcome measurement

Scientific and clinical perspective:

1.    3D VR Modeling: First automated segmentation and reconstruction model of deformed craniospinal anatomy from multiplanar imaging datasets and patient-specific model manipulation for deformity correction simulation.

2.    Non-Ionizing Imaging: Use of novel black-bone MRI sequences to protect pediatric patients from radiation exposure.

3.    AR Integration: Real-time visualization of surgical fields to improve accuracy, reduce operative time, and minimize radiation exposure.

4.    Educational Benefits: Enhancement of patient understanding and clinical education using VR and AR tools.