Conrad Günther, Dirk Winkler, Svenja Jung, Martin Hoffmann, Katharina Scheidt, Fabian Kropla, Erdem Güresir, Ronny Grunert
Although no causal relationship is established between congenital athelia and breast carcinogenesis, careful clinical and imaging evaluation is mandatory for patients with congenital nipple-areolar abnormalities. Rational application of multimodal imaging is critical for early diagnosis and long-term surveillance in this rare population.
OBJECTIVE: This study aims to evaluate the clinical utility of nextViewer, a novel spatial computing application for the Apple Vision Pro, to determine its efficacy in enhancing patient-specific neurosurgical preoperative planning, spatial comprehension, and multi-user team communication.
METHODS: A complete translational workflow was established, encompassing the segmentation of high-resolution CT/MRI scans into patient-specific 3D models and their integration into the spatial computing environment. The software leverages integrated eye- and hand-tracking to enable controller-free interaction, including 3D model manipulation, surgical trajectory drawing, and multiplanar finger-navigation. A systematic clinical evaluation was conducted with 15 experienced neurosurgeons. User satisfaction regarding user-friendliness, surgical planning benefits, system stability, and visualization quality was assessed utilizing a Likert-scale questionnaire ranging from -2 (strongly disagree) to +2 (strongly agree).
RESULTS: The application successfully facilitated intuitive, real-time manipulation of complex anatomical models, utilizing transparencies to visualize underlying critical structures. The finger-navigation feature-providing immediate crosshair updates in corresponding coronal, sagittal, and axial planes-was identified as a unique selling point for spatial orientation. Furthermore, the collaboration mode enabled synchronized, multi-user case discussions. The systematic evaluation yielded a highly positive total score of +1.7. Surgeons specifically highlighted the controller-free interaction and the exceptional graphical resolution as significant advantages over legacy visualization systems.
CONCLUSIONS: Controller-free spatial computing via the Apple Vision Pro significantly enhances neurosurgical preoperative planning. By improving real-time spatial awareness and enabling seamless interactive simulations, the nextViewer app bridges the gap between theoretical augmented reality concepts and practical clinical application. The system demonstrates strong potential to become a standard tool in neurosurgery, establishing a robust foundation for future integration with telemedicine and advanced surgical navigation.