傳統的腦部手術，醫師只能憑藉著術前影像(CT, MRI, CTA, DSA)、腦部解剖學專業和臨床經驗，規劃合適的手術路徑；手術過程中，如果不甚傷害了腦動脈，輕則造成顱內出血，重則造成病人嚴重的後遺症甚至死亡；本研究將結合CT影像輔助手術導航系統、血管分割系統與混合實境(MR, Mixed Reality)系統以即時3D視覺化方式將患部投影在病患上，提供患部、病患與手術器械空間位置資訊，幫助醫師術前精確規劃可避開腦動脈的安全手術路徑，並於術中精準定位。本研究重點分為兩部分，血管影像分割與混合實境部分。
血管分割部分，將電腦斷層腦血管影像(CTA, Computed Tomography Angiography)經過2D影像前處理與影像辨識，完成血管2D影像分割後作三維重建，將重建完成的血管與動脈瘤3D model提供醫師作精準規劃。重建血管結果顯示，解剖學特徵重要部分 如
circle of Willis 、 Cerebral Artery 、 Cerebral Vein 與顱內動脈瘤 皆有建構出 協助醫師依據
血管特徵做出安全手術的路徑規劃； 另 由模擬3D血管重建結果顯示血管直徑幾何最大誤差約為1 pixel，表示血管分割、重建結果失真程度低。
混合實境部分，經導航系統完成血管瘤、病人與MR眼鏡影像特徵板(marker)註冊(registration)後，最終藉由MR眼鏡即時顯示動脈瘤、病人和手術器械畫面，輔助醫師做更直觀規劃安全手術路徑、3D手術導航以及降低腦部手術腦動脈損傷的風險。又經MR 眼鏡相機量測 marker 空間方位精準度實驗 顯示，NDI與camera量測marker 的位移總誤差平均絕對值與角度總誤差平均絕對值為5.25mm 與 7.8°

CTA(Computed Tomography
Ang iography) image performs 2D image preprocessing and image recognition. After finishing
2D image segmentation, the system using processed image to do 3D reconstruction. It will
provide doctor vessel and surgical target 3D model to help doctor p recisely plan surgical path.
The reconstruction result show s brain anatomy important part, for example , Circle Of Willis,
Cerebral Artery, Cerebral Vein and A neurysm . Above parts have been reconstructed. It will
help doctor plan safe surgical path depending on vessel f eature. In addition, the simulation of
3D reconstruction experiment result shows that m aximum value of g eometric error of vessel
diameter is under 1 pixel. It means vessel image segmentation and 3D reconstruction result
close to reality.
MR system part, by using brain surgical navigation system, after finishing registration of
A neurysm , patient and feature board (called marker) of MR glasses, it will timely show
A neurysm , vessel on patient displayed by MR glasses. It support doctor more i ntuitively plan
s afe surgical path, 3D surgical navigation and low down risk of s urgical accident of damaged
cerebral artery. In addition, the MR glasses measure marker spacing error experiment shows
of NDI and camera measuring marker s position and angular total average a bsolute value is
5.25mm and 7.8°

[1] 衛生福利部. (2017). 105 年全民健康保險醫療統計. Available: https://dep.mohw.gov.tw/DOS/cp-3734-39021-113.html
[2] 衛生福利部. (2017.06.19). 105 年死因統計結果與分析. Available: https://www.mohw.gov.tw/cp-16-33598-1.html
[3] I. Azarmehr, K. Stokbro, R. B. Bell, and T. Thygesen, "Surgical navigation: a systematic review of indications, treatments, and outcomes in oral and maxillofacial surgery," Journal of Oral and Maxillofacial Surgery, vol. 75, no. 9, pp. 1987-2005, 2017.
[4] U. Mezger, C. Jendrewski, and M. Bartels, "Navigation in surgery," Langenbeck's archives of surgery, vol. 398, no. 4, pp. 501-514, 2013.
[5] S. C. Overley, S. K. Cho, A. I. Mehta, and P. M. Arnold, "Navigation and robotics in spinal surgery: where are we now?," Neurosurgery, vol. 80, no. 3S, pp. S86-S99, 2017.
[6] C.-S. Tseng, C.-C. Huang, and C.-S. Chen, "Development of an image-guided robotic system for surgical positioning and drilling," Robotica, vol. 25, no. 3, pp. 375-383, 2007.
[7] H.-T. Cheng et al., "The occlusion-adjusted prefabricated 3D mirror image templates by computer simulation: the image-guided navigation system application in difficult cases of head and neck reconstruction," Annals of plastic surgery, vol. 63, no. 5, pp. 517-521, 2009.
[8] S. Bernhardt, S. A. Nicolau, L. Soler, and C. Doignon, "The status of augmented reality in laparoscopic surgery as of 2016," Medical image analysis, vol. 37, pp. 66-90, 2017.
[9] A. Meola, F. Cutolo, M. Carbone, F. Cagnazzo, M. Ferrari, and V. Ferrari, "Augmented reality in neurosurgery: a systematic review," Neurosurgical review, vol. 40, no. 4, pp. 537-548, 2017.
[10] C. Karmonik et al., "Augmented Reality with Virtual Cerebral Aneurysms: A Feasibility Study," World neurosurgery, vol. 119, pp. e617-e622, 2018.
[11] D. Guha, N. M. Alotaibi, N. Nguyen, S. Gupta, C. McFaul, and V. X. Yang, "Augmented reality in neurosurgery: a review of current concepts and emerging applications," Canadian Journal of Neurological Sciences, vol. 44, no. 3, pp. 235-245, 2017.
[12] Y. Chu et al., "Registration and fusion quantification of augmented reality based nasal endoscopic surgery," Medical image analysis, vol. 42, pp. 241-256, 2017.
[13] R. Diaz, J. Yoon, R. Chen, A. Quinones-Hinojosa, R. E. Wharen, and R. J. Komotar, "Real-time video-streaming to surgical loupe mounted head-up display for navigated meningioma resection," Turk Neurosurg, p. 1, 2017.
[14] F. Cutolo et al., "A new head-mounted display-based augmented reality system in neurosurgical oncology: a study on phantom," Computer Assisted Surgery, vol. 22, no. 1, pp. 39-53, 2017.
[15] K. Maruyama et al., "Smart glasses for neurosurgical navigation by augmented reality," Operative Neurosurgery, vol. 15, no. 5, pp. 551-556, 2018.
[16] J. Wang, H. Suenaga, L. Yang, E. Kobayashi, and I. Sakuma, "Video see‐through augmented reality for oral and maxillofacial surgery," The International Journal of Medical Robotics and Computer Assisted Surgery, vol. 13, no. 2, p. e1754, 2017.
[17] J. T. Gibby, S. A. Swenson, S. Cvetko, R. Rao, and R. Javan, "Head-mounted display augmented reality to guide pedicle screw placement utilizing computed tomography," International journal of computer assisted radiology and surgery, vol. 14, no. 3, pp. 525-535, 2019.
[18] H. El-Hariri, P. Pandey, A. J. Hodgson, and R. Garbi, "Augmented reality visualisation for orthopaedic surgical guidance with pre- and intra-operative multimodal image data fusion," Healthcare Technology Letters, vol. 5, no. 5, pp. 189-193, 2018.
[19] wikipedia. (2013). Digital subtraction angiography. Available: https://en.wikipedia.org/wiki/Digital_subtraction_angiography
[20] S. Moccia, E. De Momi, S. El Hadji, and L. S. Mattos, "Blood vessel segmentation algorithms—Review of methods, datasets and evaluation metrics," Computer methods and programs in biomedicine, vol. 158, pp. 71-91, 2018.
[21] 病理世界, "圖解腦供血系統之腦動脈，你搞清楚過嗎？," 2015.
[22] V. Allen, "Clinical Indications Background," 2016.
[23] S. Kamalian, M. H. Lev, and R. Gupta, "Chapter 1 - Computed tomography imaging and angiography – principles," in Handbook of Clinical Neurology, vol. 135, J. C. Masdeu and R. G. González, Eds.: Elsevier, 2016, pp. 3-20.
[24] S. Kamath, "Observations on the length and diameter of vessels forming the circle of Willis," Journal of anatomy, vol. 133, no. Pt 3, p. 419, 1981.
[25] L. Wang, S. Lu, L. Cai, H. Qian, R. Tanikawa, and X. e. Shi, "Internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms," Neurosurgical focus, vol. 46, no. 2, p. E10, 2019.
[26] Wikipedia. (2006). The originally published 15 cube configurations. Available: https://en.wikipedia.org/wiki/Marching_cubes
[27] VTK, "CellPointNeighbors," 2013.
[28] L. Qian et al., "Comparison of optical see-through head-mounted displays for surgical interventions with object-anchored 2D-display," International journal of computer assisted radiology and surgery, vol. 12, no. 6, pp. 901-910, 2017.
[29] Microsoft. (2018). HoloLens (1st gen) hardware details. Available: https://docs.microsoft.com/en-us/windows/mixed-reality/hololens-hardware-details
[30] S. Worz and K. Rohr, "Segmentation and quantification of human vessels using a 3-D cylindrical intensity model," IEEE transactions on Image Processing, vol. 16, no. 8, pp. 1994-2004, 2007.
[31] D. Robben et al., "Simultaneous segmentation and anatomical labeling of the cerebral vasculature," in International Conference on Medical Image Computing and Computer-Assisted Intervention, 2014, pp. 307-314: Springer.
[32] D. F. Abawi, J. Bienwald, and R. Dorner, "Accuracy in optical tracking with fiducial markers: an accuracy function for ARToolKit," in Proceedings of the 3rd IEEE/ACM International Symposium on Mixed and Augmented Reality, 2004, pp. 260-261: IEEE Computer Society.
[33] 彭仲祥, "脊椎手術用2D/3D C-arm影像輔助手術導引定位系統之研發," 碩士, 生醫科學與工程學系, 國立中央大學, 桃園縣, 2018.
[34] T. David and R. G. Brown, "Chapter 7 - Models of Cerebrovascular Perfusion," in Transport in Biological Media, S. M. Becker and A. V. Kuznetsov, Eds. Boston: Elsevier, 2013, pp. 253-273.
[35] circle_ofwillis. (2019). Circle of Willis. Available: https://twitter.com/circle_ofwillis
[36] C. Atlas, "Anterior Cerebral Artery," 2015.
[37] B. SA, "CEREBRAL ARTERY, ILLUSTRATION," 2016.
[38] S. Takahashi, Neurovascular Imaging: MRI & Microangiography. Springer Science & Business Media, 2010.
[39] K. Oka, A. L. Rhoton Jr, M. Barry, and R. Rodriguez, "Microsurgical anatomy of the superficial veins of the cerebrum," Neurosurgery, vol. 17, no. 5, pp. 711-748, 1985.