• Terushige Toyooka, Naoki Otani, Kojiro Wada, Arata Tomiyama, Satoru Takeuchi, Kazuya Fujii, Kosuke Kumagai, Takashi Fujii, and Kentaro Mori.
• J. Neurosurg. 2018 Oct 1; 129 (4): 883-889.

ObjectiveThe head-up display (HUD) is a modern technology that projects images or numeric information directly into the observer's sight line. Surgeons will no longer need to look away from the surgical view using the HUD system to confirm the preoperative or navigation image. The present study investigated the usefulness of the HUD system for performing cerebral aneurysm clipping surgeries.MethodsThirty-five patients underwent clipping surgery, including 20 keyhole surgeries for unruptured cerebral aneurysm, using the HUD system. Image information of structures such as the skull, cerebral vasculature, and aneurysm was integrated by the navigation software and linked with the positional coordinates of the microscope field of view. "Image injection" allowed visualization of the main structures that were concurrently tracked by the navigation image, and "closed shutter" switched the microscope field of view and the pointer image of the 3D brain image.ResultsThe HUD system was effective for estimating the location and 3D anatomy of the aneurysm before craniotomy or dural opening in most patients. Scheduled keyhole minicraniotomy and opening of the sylvian fissure or partial rectal gyrus resection were performed on the optimized location with a minimum size in 20 patients.ConclusionsThe HUD images superimposed on the microscope field of view were remarkably useful for less invasive and more safe aneurysm clipping and, in particular, keyhole clipping.

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