Augmented reality navigation in external ventricular drain insertion—a systematic review and meta-analysis
Bibliographic record
Abstract
Abstract External ventricular drain (EVD) insertion using the freehand technique is often associated with misplacements resulting in unfavorable outcomes. Augmented Reality (AR) has been increasingly used to complement conventional neuronavigation. The accuracy of AR guided EVD insertion has been investigated in several studies, on anthropomorphic phantoms, cadavers, and patients. This review aimed to assess the current knowledge and discuss potential benefits and challenges associated with AR guidance in EVD insertion. MEDLINE, EMBASE, and Web of Science were searched from inception to August 2023 for studies evaluating the accuracy of AR guidance for EVD insertion. Studies were screened for eligibility and accuracy data was extracted. The risk of bias was assessed using the Cochrane Risk of Bias Tool and the quality of evidence was assessed using the Newcastle-Ottawa-Scale. Accuracy was reported either as the average deviation from target or according to the Kakarla grading system. Of the 497 studies retrieved, 14 were included for analysis. All included studies were prospectively designed. Insertions were performed on anthropomorphic phantoms, cadavers, or patients, using several different AR devices and interfaces. Deviation from target ranged between 0.7 and 11.9 mm. Accuracy according to the Kakarla grading scale ranged between 82 and 96%. Accuracy was higher for AR compared to the freehand technique in all studies that had control groups. Current evidence demonstrates that AR is more accurate than free-hand technique for EVD insertion. However, studies are few, the technology developing, and there is a need for further studies on patients in relevant clinical settings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.027 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.018 |
| Bibliometrics | 0.004 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".